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INSTITUTE FOR PUBLIC HEALTH

VIEWS: 11 PAGES: 158

									      INSTITUTE OF PUBLIC HEALTH
     OF THE REPUBLIC OF SLOVENIA
     Director: prim. Metka Macarol Hiti, M.D.




   INFORMATIONAL UNIT FOR DRUGS
       SLOVENIA REITOX FOCAL POINT




THE REPUBLIC OF SLOVENIA

       National Report

                   2001



          Tatja Kostnapfel Rihtar,
      National focal point coordinator
                           National report was prepared by:

      Tatja Kostnapfel Rihtar, M.Sc., National focal point coordinator

Experts contributing with qualitative information and data
              (in alphabetical order and in enclosed in figure)

Miran Belec, W.W.                   Institute for Public health of the Republic of Slovenia
Tomo Hasovič                        Ministry of Interior
Prof. Vito Flaker, Ph.D.            School for Social Work
Andrej Kastelic, M.D.               Center for Treatment of Drug Addicts
                                    Coordination of Centres for the Prevention and
                                    Treatment of Drug Addiction at the Ministry of Health
Irena Klavs, M.D., M.Sc.            Institute of Public health of the Republic of Slovenia
Livio Kosina                        Ustanova Odsev se sliši
                                    The Sound of Reflection Foundation
Dare Kocmur                         Aids Foundation Robert
Lidija Kristančič, B.Sc.            Ministry of Health of the Republic of Slovenia
Milan Krek, M.D.                    Governmental Office for Drugs
Evita Leskovšek, M.D.               Institute of Public health of the Republic of Slovenia
Dušan Nolimal, M.D., M.Sc.          Institute of Public health of the Republic of Slovenia
Olga Perhavc,                       Central Prison Administration
Vesna Kerstin Petrič, M.D.          Ministry of Health of the Republic of Slovenia
Ljubo Pirkovič                      Ministry of Interior of the Republic of Slovenia
Matej Sande, M.Sc.                  DrogArt
Peter Stefanoski, B.Sc.             Ministry of Labour, Family and Social Affairs of the
                                    Republic of Slovenia
Eva Stergar, M.Sc.                  Institute of Public health of the Republic of Slovenia
Joţica Šelb, M.D.                   Institute of Public health of the Republic of Slovenia
Milan Škrlj, M.Sc.                  Ministry of Health of the Republic of Slovenia
Miljana Vegnuti, B.Sc.              Institute of Public health of the Republic of Slovenia
Alenka Verbek Garbajs, B.Sc.        Ministry of Interior of the Republic of Slovenia
Martin Vrančič                      Ministry of Interior of the Republic of Slovenia
Dr. Majda Zorec Karlovsek           Institute for Forensic Medicine, Medical Faculty,
                                    University of Ljubljana
Darko Ţigon                         Republic Custom Office
Contact:

Tatja Kostnapfel Rihtar, M.Sc., National focal point
coordinator

Institute of Public Health of the Republic of Slovenia
Informational Unit for Drugs
Trubarjeva 2
1000 Ljubljana
SLOVENIA


Tel.: 00 386 1 2441 400
               2441 401
               2441 479
Fax.: 00 386 1 2441 447

e mail:
metka.hiti@ivz-rs.si
tatja.kostnapfel@ivz-rs.si




Technical assistance: Vili Prodan




LJUBLJANA, FEBRUARY 2002
NOTE:


1.   Some of the data stated in this report has not been collected
     by the regular EMCDDA methodology, but they result from
     separate researches carried out by individual researchers.


2.   For all data are responsible experts who contributed them to
     the Report.
Table of contents


PART 1          NATIONAL STRATEGIES: INSTITUTIONAL & LEGAL
                FRAMEWORKS.............................................................................. 1
 1.          Developments in Drug Policy and Responses .................................... 2
      1.1. Political framework in the drug field ......................................................... 2
      1.2. Policy Implementation, legal framework and prosecution ........................ 7
        a)      Law and regulations ......................................................................... 7
        b)      Prosecution policy, priorities and objectives in relation to drug
                addicts, occasional users, drug related crime ................................. 10
        c)      Any other important project of law or other initiative with political
                relevance to drug related issues ..................................................... 11
      1.3. Developments in public attitudes and debates ...................................... 11
      1.4. Budgets and funding arrangements ...................................................... 15
        a)      Funding (figures) at national level in following fields: ...................... 15
PART 2          EPIDEMIOLOGICAL SITUATION ................................................. 16
 2.          Prevalence, Patterns and Developments in Drug Use ...................... 17
      2.1. Main developments and emerging trends ............................................. 17
      2.2. Drug use in the population .................................................................... 21
        a)     Main results of surveys and studies ................................................ 21
        b)     General population ......................................................................... 22
        c)     School and youth population .......................................................... 23
        d)     Specific groups (e.g. conscripts, minorities, workers, arresters,
               prisoners, sex workers, etc.) ........................................................... 24
      2.3. Problem drug use .................................................................................. 25
        a)     National and local estimates, trends in prevalence and incidence,
               characteristics of users and groups involved, risk factors, possible
               reasons for trends .......................................................................... 25
        b)     Risk behaviours (injecting, sharing, sex…) and trends ................... 26
 3.          Health Consequences ....................................................................... 27
      3.1.      Drug treatment demand ........................................................................ 27
      3.2.      Drug-related mortality ............................................................................ 30
      3.3.      Drug-related infectious diseases ........................................................... 33
      3.4.      Other drug-related morbidity ................................................................. 34
        a)          Non-fatal drug emergencies ........................................................... 34
        b)          Psychiatric co-morbidity ................................................................. 34
        c)          Other important health consequences (e.g. drugs and driving,
                    acute and chronic drug effects...) ................................................... 35
 4.          Social and Legal Correlates and Consequences .............................. 38
      4.1. Social problems .................................................................................... 38
        a)     Social problems - social exclusion .................................................. 38
      4.2. Drug offences and drug-related crime ................................................... 40
      4.3. Social and economic costs of drug consumption ................................... 43
 5.          Drug markets ..................................................................................... 44
      5.1.      Availability and supply ........................................................................... 44
      5.2.      Seizures ............................................................................................... 44
      5.3.      Price/purity ............................................................................................ 46
 6.          Trends per Drug ................................................................................ 47
 7.          Conclusions ....................................................................................... 49
PART 3          DEMAND REDUCTION INTERVENTIONS .................................. 50
 8.          Strategies in Demand Reduction at National Level ........................... 51
      8.1.      Major strategies and activities ............................................................... 51
      8.2.      Approaches and new developments ..................................................... 53
 9.          Intervention Areas ............................................................................. 55
      9.1. Primary prevention ................................................................................ 55
        9.1.1. Infancy and Family ......................................................................... 55
        9.1.2. School programmes ....................................................................... 56
        9.1.3. Youth programmes outside schools ............................................... 63
        9.1.4. Community programmes ................................................................ 64
        9.1.5. Telephone help lines ...................................................................... 64
        9.1.6. Mass media campaigns .................................................................. 65
        9.1.7. Internet ........................................................................................... 66
      9.2. Reduction of drug related harm ............................................................. 67
        9.2.1   Outreach work ................................................................................ 67
        9.2.2. Low threshold services ................................................................... 68
        9.2.3. Prevention of infectious diseases ................................................... 70
        9.3.1. Treatments and Health care at national level.................................. 72
        9.3.2. Substitution and maintenance programmes ................................... 79
      9.4. Aftercare and reintegration .................................................................... 88
      9.5. Interventions in the Criminal Justice System ......................................... 88
      9.6.   Specific targets and settings ................................................................ 96
 10.         Quality Assurance ........................................................................... 100
      10.1.     Quality assurance procedures ..............................................................100
      10.2.     Treatment and prevention evaluation ...................................................100
      10.3.     Research .............................................................................................105
        a)          Demand reduction research projects: ............................................105
        b)          Relations between research and drug services .............................105
        c)          Training in demand reduction research .........................................109
      10.4.     Training for professionals .....................................................................111
PART 4          KEY ISSUES .............................................................................. 113
 11.         Infectious diseases .......................................................................... 114
      11.1. Prevalence of HIV, HCV, and HBV among injecting drug users ...........114
      11.3. New developments and uptake of prevention,
            harm reduction and care ......................................................................118
 12.         Evolution of treatment modalities .................................................... 121
      12.1. Introduction ..........................................................................................121
      12.2. Legislation/regulations that had an effect on a treatment provision ......121
ANEX 1..................................................................................................... 128
   References .....................................................................................................128
ANEX 2..................................................................................................... 136
   Drug Monitoring Systems and source of information .......................................136
   1.      Evolution ..............................................................................................136
   2.      Legislation ............................................................................................137
   3.      Sources of information .........................................................................138
      3.1.     Epidemiology.................................................................................138
      3.2.     Demand reduction .........................................................................139
      3.3.     Documentation centres .................................................................139
ANEX 3..................................................................................................... 140
   List of Abbreviations .......................................................................................140
ANEX 4..................................................................................................... 141
   List of Tables ..................................................................................................141
ANEX 5..................................................................................................... 142
   List of Figures .................................................................................................142
ANEX 6..................................................................................................... 143
   List of Institutions ............................................................................................143
ANEX 7..................................................................................................... 150
   Standardised Epidemiological Tables .............................................................150
                             The Republic of Slovenia - PART 1
 NATIONAL STRATEGIES: INSTITUTIONAL & LEGAL FRAMEWORKS




               PART 1

NATIONAL STRATEGIES:
INSTITUTIONAL & LEGAL
     FRAMEWORKS




                        1
                                          The Republic of Slovenia - PART 1
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1.    Developments in Drug Policy and Responses


1.1. Political framework in the drug field

Use and misuse of heroin, cannabis and other illegal drugs have been present
in Slovenia since 1960s. Until 1990s it has been believed that illegal drug use is
not a considerable problem in Slovenia. Becoming an independent country we
have soon recognised drug problem as a topic of high priority. Rising HIV
epidemic in some neighbouring countries among intravenous drug users has
resulted in reconsideration of existing policies. In 1992 the National Programme
was accepted in Parliament and the National Committee for the Implementation
of National Programme for the Prevention of Drug Misuse was established.

In 1994 the Government of Slovenia accepted the advisory role of UNDCP for
preparation of new legislation and organisational framework for the field of
drugs. The new structures were proposed within the Government to create a
better co-ordination of national drug policy.

In 1990s an extensive cooperation with international organisations like UNDCP,
PHARE Programme, the Pompidou Group/Council of Europe and WHO in
particular has outlined the basis of national drug policy. Harm reduction
approaches have become more readily accepted through this cooperation.

Cooperation with the Pompidou Group/Council of Europe has contributed to the
faster development of drug epidemiology. There were two »Information systems
and applied epidemiology of drug misuse« seminars held in Slovenia (Ljubljana
1993, Piran 1994). The primary purpose of these courses was to give the
expertise to help us developing a data collection system for planing and
evaluating policies and interventions on drug misuse. The goal was to provide
an input that would enable our professionals to build on their own experience
and identify an appropriate strategy for research and data collection in Slovenia.
The second purpose was to be more compatible with the work of the Pompidou
Epidemiology Group.

The methadone maintenance treatment was present in Slovenia since 1991. In
1994 the consensus on the implementation of the methadone maintenance
programme in Slovenia reached to the national level (The Conference on
Methadone, Gozd Martuljek, November 1994). In April 1995 the network of
Centres for the Prevention and Treatment of Drug Addiction (CPTDA) has
started to establish.
The Coordination of Centres for the Prevention and Treatment of Drug
Addiction and the Supervising Committee were formed at the Ministry of Health
to guarantee a good realization and supervision.




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In 1996 outreach, a method of work with harm reduction activities, was
discussed at the meeting at Otočec, cosponsored by the Pompidou Group.

At the beginning the initiative for outreach activities was coming from the
governmental structures, but soon Non-governmental organizations (NGO)
started to get involved. Nevertheless, outreach has been already presented in
Slovenia before the Otočec meeting. NGOs as Piramida in Maribor, Stigma in
Ljubljana and Komet in Koper have been executing some outreach activities
since 1990. The Republic of Slovenia was included in WHO pilot project "HIV
related harm reduction programme among injecting drug users in
Slovenia", too.

Prevention, targeting life style and better health are included in the strategy
presented in the document Health for all until the year 2000.

In October 1996 the First Slovenian Conference on Addiction Medicine was
held in Ljubljana. The main issue was to explain the major ideas of addiction
medicine and review Alpe-Adria region. First publication on this issue has been
published in 1997.The Second conference on Addiction medicine was held
in 1998.

The 3rd European Methadone Conference together with the Regional
meeting of Central and Eastern European Countries on Therapeutic
Programmes for Drug Addicts and European Conference on Outreach and
Open Community Approach was organised in September 1997 by the
Coordination of Centres for the Prevention and Treatment of Drug Addiction at
the Ministry of Health and EUROPAD (European Opiate Addiction Treatment
Association).

The First National Conference on Addiction was organised by the
Coordination of Centres for the Prevention and Treatment of Drug Addiction at
the Ministry of Health and The Sound of Reflection Foundation in May 1999.

ISAM (International Society of Addiction Medicine) Satellite Symposium was
organised in September 2001 by the The Sound of Reflection Foundation and
ISAM, followed by the WHO Workshop on Pharmacological Treatment of
Opioid Dependence, organised by the same foundation.


Drug Information System in Slovenia has been developing since 1991 in
agreement with the Pompidou Group methodology and Phare DIS Programme.
The National Public Health Institute has been the chief actor in drug data
collection. Nevertheless, we had also done some activities before.
FTD data has been collected since 1991 in the Centre for the Prevention and
Treatment of Drug Addiction Koper and systematically since 1996 in all
CPTDAs.




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The decision was made at the ministerial level that the Ministry of Health would
act as the Slovenian Focal Point, cooperating with the National Public Health
Institute in connection with epidemiology in 1994.
Legal basis is now in the Act on prevention of drug consumption and treatment
of drug addicts (Official gazette 98/99).

In Slovenia, according to available estimates, are from 5,000 to 10,000
intravenous drug users (25-50/10.000 population). Sharing equipment for
injecting drugs (80%) as well as unsafe sex are common, dangerously
increasing the potential for spreading the HIV in this community.
But out of nine gathered reported aids cases in Slovenia in 1999 there was only
one with the history of possible intravenous drug use.
Several hundred intravenous drug users have been voluntarily and confidentially
tested for HIV in recent years and only three have been found infected. However,
the present low prevalence of the HIV infection among intravenous drug users
may increase rapidly whenever and if HIV is introduced. Therefore HIV harm
reduction interventions related to unsafe intravenous drug use and unsafe sexual
behavior among drug users are considered a high priority within the National AIDS
Prevention and Care Program.
That is why a network of fifteen regional centers for the Prevention and
Treatment of Drug Addictions has been established since 1995 and the
professional staff working at the centers has received an additional training.
These facts might also contribute to low HIV prevalence in this population,
together with introduction of substitutive treatment a few years earlier.


International cooperation

Slovenia is participating in several international programmes and cooperating
with several international organisations dealing with drug issues. International
cooperation has played an important role in facilitating certain activities such as
implementation of harm reduction approaches. It has also provided knowledge
and international experiences to our experts. Although international cooperation
has certainly influenced drug policy in Slovenia, all programmes and
measurements were adapted to national circumstances.

Since 1993 we have been participating in the PHARE programme in several
fields:
Drug Demand Reduction
Drug Supply Reduction
Drug Information Systems
Control on Precursors
Licit Drug Control
Money Laundering Project
Synthetic Drug Project

Phare projects have often been used as an excuse to initiate certain activities
on the national level.



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One of the most important roles of Phare Projects is in facilitating international
cooperation between CEECs and EU countries. Although the cooperation
between Slovenia and other CEECs and EU countries concerning drug
information systems and data exchange is presently mainly through Phare
Projects and some other international projects, it is an excellent starting point
for future cooperation on more independent bases.

Phare Project "Strengthening of the national REITOX Focal Point and
strengthening the drug supply reduction and drug demand reduction
programmes in Slovenia" (SI0005/IB/JH-02) is recognised as a facilitating
phase of cooperation with the EMCDDA and REITOX.

Due to present international political status, police has not yet been able to
establish closer institutional cooperation with the European Union. Drugs,
organised crime and money laundering are considered a serious international
problem. The efficient prevention will no longer be possible without closer
cooperation among prosecuting authorities in all European countries.

Within the Phare Multi-Beneficiary Drugs Programme of the European
Commission, oriented towards the transposition of the European Union acquit in
the field of drugs, we organized this year (2001) the Phare Synthetic Drugs
Project in the Republic of Slovenia. It was carried out and coordinated by the
Criminal Police. Through the realisation of all envisioned activities (trainings,
study visits and a seminar) the basic aims of the project were entirely realised.
An important result of the project was the preparation of the National Synthetic
Drugs Plan of Activities that will become a component part of evolving national
drug strategy. Through establishment of the Europol National Bureau and with
the signing of the Agreement on cooperation between the Slovene Police and
the Europol, the conditions for active participation in the EU Early Warning
System have been created. This system based on the Joint Action on Synthetic
Drugs from 1997 and represents an effective tool for early identification of new
synthetic drugs. Within the frame of 2001 Phare programme cited above was
also concluded the fifth phase of the project “Precursors”, already a number of
years supervised and directed by our Criminal Police. During the last phase of
the project a number of activities had been carried out, oriented especially into
final harmonisation of Slovene legislation with EU directives and regulations in
the field of precursors control.

To increase the operational abilities of Slovene law enforcement authorities, we
established the Central Drug Law Enforcement Commission in 2001. The basic
task of this Commission, composed of representatives from Criminal and
Uniformed Police and from Customs, is the coordination of all activities in the
field of drug supply reduction.

The Republic of Slovenia is actively involved in accession into the European
Union in the sense of harmonisation of legislation and other institutional
changes in the field of illicit drugs, including the implementation of the Phare



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project “Twinning Project for Prevention and Suppression of Organised
Crime”.

The cooperation with the Pompidou Group/Council of Europe has started in
1993 and has been formalised in 1994. It has resulted in several seminaries
and projects launched in Slovenia. Several Slovenian experts have got a
chance to cooperate in different working groups. The cooperation with the
Pompidou Group was most beneficial in drug epidemiology. Among numerous
programmes Multi city study, ESPAD school survey and DRSTP have given
most beneficial results.

The cooperation with UNDCP resulted in the preparation of new legislation and
reorganisation of governmental structures responsible for drug issues.
Within the framework of the UNDCP we are participating in the Sub-regional
Programme involving six projects. The countries that are taking part in it are
Poland, the Czech Republic, the Slovak Republic, Hungary and Slovenia. The
Government of the Republic of Slovenia has verified and signed the
Memorandum on Cooperation on these projects, although it has not yet
approved the projects or participants. We have not yet received any training
from the UNDCP nor have been offered any assistance in equipment.

On the bilateral level of cooperation among PECO states we have the most
intensive contacts with the Republic of Hungary and signed with it several
agreements on cooperation in the police field. With the Slovak Republic we
have already signed an agreement on cooperation in the fight against terrorism,
illicit drug trafficking and organised crime. The same agreement is just about to
be signed with the Czech Republic and Poland. We exchange concrete
operational information via the Interpol CNB without any obstacles.

We are founder members of the Middle European Police Academy (MEPA),
whose training programme includes drug related issues. Our experts are not
only students, but also take a part as Iecturers.

Our representatives are actively involved in the work of the committees of the
Central European Initiative (CEI).

With two groups of crime investigators we participate at the ILEA education and
training programmes in Budapest. This is an acquisition of new knowledge and
exchange of experiences, a basis of the quality work. Through this programme
we can actively cooperate with others in the preparation of training
programmes, respectful to our specific needs. ILEA programmes are designed
with special attention to drug related problems. Our aim for the future is
therefore to continue benefiting from ILEA courses on all fields of police work,
especially in the war against drugs.

The Cooperation with WHO Regional Office has resulted in Slovenia-Czech
Republic Collaborative Project in which Slovenian experience in methadone




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                                          The Republic of Slovenia - PART 1
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maintenance has been exchanged for Czech experiences in outreach work.
WHO has also financed several publications about drugs.

International Labour Organisation (ILO) has been cooperating with the
Ministry of Labour, Family and Social Affairs and The Public Health Institute on
the project about drug use at the workplace.

Open Society Institute has co financed needle exchange programme at
Stigma self help organisation. They established a partnership between Stigma
and Lifeline, similar organisation from Manchester in U.K.

Most of the international and national projects launched in Slovenia are
coordinated on inter ministerial level and discussed and agreed at the
Committee for the implementation of the National Programme for the prevention
of drug misuse. National coordinator for PHARE Programme and coordinators
for Drug Demand Reduction Project and DIS Project are all members of the
Committee.


1.2. Policy Implementation, legal framework and prosecution

a)   Law and regulations

Slovenia has signed The Single Convention on Narcotic Drugs from 1961
(Official gazette SFRJ 2/64, 3/78), The Convention on Psychotropic Substances
from 1972 (Official gazette SFRJ 40/73) and The United Nations Convention
against Illicit Traffic in Narcotic Drugs and Psychotropic Substances from 1988.
All of them were adopted in the Act on Succession - (Official gazette RS 9/92).

These and the recommendations of the Legal Advisory Programme at the
United Nations International Narcotic Board (Mr. Bernard Leroy, UNDCP Legal
Adviser) formed the basis for creating new drug legislation in Slovenia. Three
new Acts were adopted.

1.   The Act on production of and trade in narcotic drugs and
     psychotropic substances (Official gazette RS 108/99, 44/00)

This Act shall set out the conditions under which the production of and trade in
illicit drugs are permitted, and the possession of illicit drugs.

Illicit drugs shall be deemed to be plants and substances of natural or synthetic
origin which have psychotropic effects and which can influence a person‟s
physical or mental health or threaten a person‟s appropriate social status, and
which are defined in the list referred to in the third paragraph of this article.

The production of illicit drugs shall be deemed to be all procedures in which
substances from article 2 of this Act are obtained, including their cultivation,
processing and final preparation.



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For the purpose of this Act, trade in illicit drugs shall be deemed to be the
import, export, transit and sale of illicit drugs and any other method of releasing
illicit drugs into circulation.

The possession of illicit drugs shall be prohibited, except under conditions
specified in Articles 7 and 19 of this Act.

The production of illicit drugs may be performed on the basis of a licence
obtained from the minister responsible for health.

Opium poppy (Papaver Somniferum) and cannabis (Cannabis Sativa l.) may be
cultivated solely for food or industrial purposes on the basis of a licence issued
by the ministry responsible for agriculture.
Illicit drugs may be released into circulation exclusively on the basis of a licence
issued by the minister.

Applications for the issuing of a licence for trade in illicit drugs shall be
submitted to the ministry responsible for health.


The act is being implemented by regulations to be prepared by the Ministry of
Health and other responsible ministries.

The List of Illicit Drugs Decree (Official gazette RS 49/00, 8/01, 49/01).

    The Regulation on Terms and Proceedings to Issue Permissions for
     the Export and Import of Drugs (Official gazette 8/02).

The Regulation on Evidences and Reports on Drug Production and Trade and
Terms of Data Reporting is being prepared by the Ministry of Health and
Degree on bookkeeping and health inspection.

In addition, licit drugs are partly regulated by the Medicinal Products Act (Official
gazette 101/99).


2.    The Act on prevention of drug consumption and treatment of drug
      addicts (Official gazette 98/99).

In this unique act the addiction and the measures for the primary, secondary
and tertiary prevention, treatment of drug misuse and rehabilitation and social
reintegration are defined. The law also defines the harm reduction measures.
Activities and responsibilities of state and establishment of coordinating body at
the governmental level are specified.
In this act Inter ministerial Committee is defined and The Governmental Office
for Drugs.




                                         8
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The Commission of the Government of the Republic of Slovenia for Drugs shall
promote and coordinate the governmental policy and programmes for the
prevention of illicit drugs consumption, reduction in illicit drug demand, reduction
in harm caused by the use of illicit drugs, treatment and rehabilitation.
In addition the Commission of the Government of the Republic of Slovenia for

Drugs shall perform the following tasks:
 monitor the implementation of the provisions of conventions issued by
   international bodies and international organisations;
 submit to the Government of the Republic of Slovenia the proposed National

Programme and measures for the implementation of the National Programme;
 propose measures to reduce illicit drug supply;
 ensure international cooperation.

The Information System has its legal basis in this law.
Monitoring of the consumption of illicit drugs is carried out in the form of the
collection, arrangement, processing and providing of information on illicit drugs,
consumers of illicit drugs and consequences of the use of illicit drugs. The
purpose is to ensure a national information network, interdepartmentally
coordinated collection of data and an informational exchange on the national
and international levels.
The activities specified in the preceding paragraph shall be carried out by the
competent ministries, public institutions and non-governmental organisations.
The competent minister shall set out the method of monitoring in the working
areas of individual ministries in more detail.
Monitoring of the consumption of illicit drugs shall be carried out pursuant to the
provisions that govern collections of data in the area of health and in
accordance with the act that governs the protection of personal data.
For the implementation of the activities specified in the first paragraph of this
article, the ministry responsible for health shall organise an illicit drug
information unit.
The information unit referred to in the preceding paragraph shall include all
competent ministries, public institutions and non-governmental organisations,
along with the collections of data in the available area of illicit drugs.

According to this act two degrees were adopted:
 Degree on establishing and performing of Coordination of Centres for the
   Prevention and Treatment of Drug Addiction (Official gazette 43/00)
 Degree on establishing and performing Supervision Commission (Official
   gazette 43/00)


3.   Precursors for Illicit Drugs Act (Official gazette 22/00)

The actregulates in details the monitoring of export and import and partially the
domestic trade, the list of precursors and its amending in accordance with the
amendments of EU and OUN legislation. The Commission on precursors was



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established with duties to monitor the application of the act; the conditions for
persons dealing with precursors were defined; the procedure for issuing
licenses and procedure for export/import precursors scheduled to categories 1,
2 and 3 were arranged; special control measures were applied for export to
sensitive; the recording and reporting, inspection and penal measures were
regulated.


Degrees are:
Decision on the list of precursors (Official gazette 94/2000)
Decision on the quantities of precursors which may be exported without
permission (Official gazette 94/2000)
Decision on the list of precursors and states for applying special measures in
exports (Official gazette 94/2000)


b)   Prosecution policy, priorities and objectives in relation to drug
     addicts, occasional users, drug related crime

1.   Penal Code

According to the Penal Code of the Republic of Slovenia (Official gazette RS
63/94 - paragraph 196 and 197) illegal production of and trade in narcotic drugs
and psychotropic substances and facilitation of illegal drugs use are defined as
criminal acts.

The possession of illegal drugs being recognised as for a personal use only is
not considered criminal act but an offence according to the Act on Production
and Traffic of Narcotics (Official gazette 108/99).

The compulsory treatment for addicted on alcohol and drugs is defined in the
paragraph 66 of the Penal Code. A person who committed criminal act owing to
his/hers alcohol or drug addiction may be sentenced to compulsory treatment.
Treatment may take place in prison or in treatment institution. In a case of
conditional sentence, the judge may consider doers readiness for treatment and
permits treatment from liberty.

Compulsory treatment for alcohol and drug addicts is discussed in the Penal
Code (Official gazette RS 17/78, paragraphs 162,163,164 and 165).


New substances under control in the reporting year directives

GHB was classified to the list of illicit drugs according to the List of Illicit Drugs
Decree in 2002 (Official gazette RS 49/01).




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c)    Any other important project of law or other initiative with
      political relevance to drug related issues


Since 1999 the Governmental office for Drugs are preparing the National Drug
Strategy and National Action Plan among different sectors. They will be
launched to the parliament procedure in 2002.

All degrees on the basis of law on drugs are in a phase of preparation.


1.3. Developments in public attitudes and debates


    National level

On the basis of the Acton prevention of drug consumption and treatment of drug
addicts (Official gazette 98/99) Governmental Office for Drugs was established.

Its predecessor at the governmental level was the National Committee for the
Implementation of National Programme for the Prevention of Drug Misuse
established in 1992. The Committee was designed as a consultant body of the
Government. Lack of executive power has been a main limitation of the
Committee. It could only influence through its members‟ consultations with
ministers and other executives of the Government and through the media.


The Ministry of Health has several tasks. It is competent for preparing of
legislation and responsible for treatment. It is competent for establishment of
two legal evidenced bodies: Coordination of Centres for the prevention and
treatment of drug addiction and Supervision Commission for monitoring the
Centres for Prevention and Treatment of Drug Addiction.

Among other activities the Ministry of Health is responsible for issuing import
and export authorisations for illicit drugs and precursors, organizing seminaries,
allocating budgetary resources and preparing list of Illicit Drugs.

The Ministry of Labour, Family and Social Affairs is responsible for social
rehabilitation and integration. Under its domain is the cooperation with
International Labour Organisation regarding prevention at the work place.
Supporting outreach work and other harm reduction activities is one of its
responsibilities.

The Ministry of Interior has the competence for fighting drug related crime. It
is also a reliable source on drug related police data.

The Ministry of Justice - UIKS deals with addicted prisoners and has been
successful in this matter cooperating with health sector.



                                        11
                                           The Republic of Slovenia - PART 1
               NATIONAL STRATEGIES: INSTITUTIONAL & LEGAL FRAMEWORKS



The Ministry of Finance - Custom Office of the Republic of Slovenia is
responsible for customs affairs and as such also dealing with drug issues.

The Ministry of Education and Sport is responsible for the primary prevention
in schools. In this context it cooperates with health sector, mainly with the
Institute of Public Health. The school survey ESPAD was a result of such
cooperation.

The Ministry of Defence is involved in drug demand reduction activities
considering the population of young recruits for which is responsible.

The Institute of Public Health of the Republic of Slovenia (IPH) deals with
drug related data collection and dissemination at national level. Within the
scope of its general tasks is responsible for prevention and health promotion at
all levels. AIDS and hepatitis prevention and monitoring are part of the
Institute‟s activities. The IPH cooperates with all bodies at local, national and
international levels.


   Regional level

Several drug related activities are organised at the regional (geographical) level:

Prevention

Local Action Groups (LAG) have been established in several regions (there
are 9 regions in Slovenia). Their domain is primary and secondary prevention.
The local authorities finance them and there is a significant difference among
the involvement of LAT in different regions.

Treatment

Centres for the Prevention and Treatment of Drug Addiction (CPTDA) have
been mostly established at the regional level within the health centres or public
health institutes. They differ widely in the number of clients. Methadone
maintenance programme and counselling are predominant services.

Center for Treatment of Drug Addicts at Clinical Department for Mental
Health was established in 1995 and additionally financially supported from
1998. Center for Treatment of Drug Addicts should be opened in 2002.



Epidemiology and research




                                        12
                                           The Republic of Slovenia - PART 1
               NATIONAL STRATEGIES: INSTITUTIONAL & LEGAL FRAMEWORKS


There is the Institute for Public Health in each region, collecting, analysing and
disseminating health data and dealing with health promotion at the regional
level. Collecting drug related data is only one of the institute‟s activities.


Mechanisms of cooperation and coordination

At the national level the cooperation between all governmental sectors, media
and NGOs is assured within the Governmental Office for Drugs which
guaranties multidisciplinary approach.

Coordination of CPTDAs at the Ministry of Health is the coordinating body,
established to provide uniform treatment approach in all treatment centres and
exchange of treatment experiences. The representatives of therapeutic
communities and harm reduction programmes are invited to meetings as non-
members of Coordination - representatives from Ministry of Health, Institute of
Public Health, Ministry of Labour, Family and Social Affairs, Ministry of Justice
and representatives of NGO.

The initiative to create similar coordination of regional Public Health Institute for
drug epidemiology issues has already been given. The main reason for this
initiative was a need to adopt same methodology of data collection at all levels.

Several networks have been created in the past few years in Slovenia to create
common policy and uniform approach and exchange experiences. Among those
we should mention The Network of LAG who at their second meeting in
October 1997 adopted several conclusions concerning LAG preventive
activities. Now meetings are performed regularly once a year.

A network of outreach projects has been established to ensure better position of
outreach projects in our country.


Non-governmental organisations

The Act on prevention of drug consumption and treatment of drug addicts
(Official gazette 98/99) defines in:

Article 13

“In accordance with this Act, non-governmental organisations shall carry out
activities which have been coordinated with the National Programme and which
supplement the public service activities in the area of prevention and dealing
with addiction to illicit drugs.
The activities of non-governmental organisations may cover schooling and
educational activities, preventive activities, harm reduction programmes,
programmes of establishing and maintaining abstinence, social rehabilitation
and reintegration and other forms of dealing with consumers of illicit drugs and



                                         13
                                           The Republic of Slovenia - PART 1
               NATIONAL STRATEGIES: INSTITUTIONAL & LEGAL FRAMEWORKS


their relatives pursuant to the second paragraph of Article 2 of this Act and the
National Programme referred to in Article 3 of this Act.
The activities under the preceding paragraph may be carried out by non-
governmental organisations within resident communities, non-residential
programmes and as a part of other forms of work coordinated with the National
Programme.
Residential communities shall be deemed to be therapeutic communities which
carry out professional therapeutic and rehabilitation programmes, communes
via a programme which is mainly based on mutual help, and special-care
homes via a programme which is mainly based on life and work in groups.
Non-residential programmes are day centres carrying out programmes of
organised help in which consumers of illicit drugs and the people closest to
them are included alongside their everyday life. Centres carry out programmes
for the reduction of harmful consequences of the use of illicit drugs and their
programmes are carried out in the form of fieldwork.
Programmes for harm reduction cover distribution of intravenous injection
needles, advice on reducing the harm caused by the use of illicit drugs and
other programmes intended for harm reduction.
Programmes in the form of fieldwork shall be programmes of dissemination of
informational material, dissemination of medical material and other programmes
carried out in the form of fieldwork.

Article 14

The non-governmental organisations referred to in the preceding paragraph
may voluntarily associate in the Association of Non-Governmental
Organisations.
The activities of the Association of Non-Governmental Organisations shall be
the following:
 coordination of joint activities;
 mutual linking between member organisations;
 coordination of activities and programmes;
 representation of the Association of Non-Governmental Organisations before
   public and national bodies, local community bodies and holders of public
   authorisations;
 promotion of the development of non-governmental forms of work among
   consumers of illicit drugs;
 acquisition of donations for non-governmental forms of work with consumers
   of illicit drugs;
 provision of advice for governmental and other services and organisations;
 promotion of professional development and education for members of the
   organisations.


Specialised institutions in the field of drugs

There are a lot of institutions specialised in drug issues.
List of all of them is included in Annex 6.



                                         14
                                            The Republic of Slovenia - PART 1
                NATIONAL STRATEGIES: INSTITUTIONAL & LEGAL FRAMEWORKS



1.4. Budgets and funding arrangements


a)    Funding (figures) at national level in following fields:


    Law enforcement (criminal system, police forces, etc.)

Measures aimed at fighting drugs are funded by the budgets of the responsible
Ministries (the Ministry of Internal Affairs, the Ministry of Justice, the Ministry of
Finances).


    Prevention and treatments

Preventive activities are financed from regional and national budgets. Private
money is seldom involved.

Treatment organised within the National Health System is mainly funded by
the health insurance system.
Methadone maintenance in CPTDAs is available to all drug users through
compulsory health insurance. Detoxification and treatment in psychiatric
hospitals are available to all drug users through additional health insurance.

Treatment in therapeutic communities have no legal bases to be financed by
health insurance, thus special funds have been established lately within the
Ministry of Labour, Family and Social Affairs. Therapeutic communities are
financed from various budgets and donations according to their background.


    Epidemiology, research

Drug research is financed from national budgets, partly as a regular activity of
research institutions and partly from special funds at the responsible ministries.
At the local level research may be co financed from regional budgets. In some
cases research has been supported by international organisations (Open
Society Institute, WHO, UNAIDS, Pompidou Group…).


    Evaluation, quality, training

Evaluation, quality, training is financed from national budgets, partly as a
regular activity of research institutions and partly from special funds at the
responsible ministries.




                                          15
                  The Republic of Slovenia - PART 2
                   EPIDEMIOLOGICAL SITUATION




         PART 2

EPIDEMIOLOGICAL SITUATION




            16
                                                 The Republic of Slovenia - PART 2
                                                  EPIDEMIOLOGICAL SITUATION



2.     Prevalence, Patterns and Developments in Drug
       Use

2.1.   Main developments and emerging trends

In this part of the report the main developments in drug use, including
prevalence and patterns are given. Some main activities and some
epidemiological information are discussed.

In Slovenia, as in many other countries, the continuing upward trend in the
misuse of illegal drugs has been noticed since 1986.

The illicit drug situation in Slovenia seems to be very much alike to the situation
in some other European countries. The drug that causes most problems is
heroin, but the most popular drug is cannabis. Since heroin injecting is the
predominate route of opiates use, we have been lucky enough not to
experience AIDS/ HIV epidemic among the injection drug users. Heroin users in
Slovenia administer the drug in various ways. They inject the drug in their veins
(intravenously). The latter seems to be the norm among most users. Heroin is
also smoked in specially prepared cigarettes. In addition, some people use the
drug intranasally (sniffing). Among the users in treatment in 2000, 64.5%
injected their heroin and 35.3% admitted sharing at least once in their life.
13.5% of the first treatment demanders admitted sharing in the last month.
However, discussions with the fieldwork respondents suggest that among out-
of-treatment users the prevalence of sharing may well be much higher. Whether
this is really the case should be the object of systematic research, but several
observations support this hypothesis.


The use of new synthetic drugs

The use of synthetic drug is increasing in the Republic of Slovenia. Main
activities of the DrogArt - Slovenian Association for Drug related Harm
Reduction projects are built around the link of electronic culture and dance
drugs.

1. Harm reduction

From the harm reduction aspect the work includes the distribution of flyers,
outreach work (first aid) in rave parties, workshops for young people, lectures
for staff and parents in boarding homes, peer education and voluntary work. We
are using Internet as a tool for prevention of dance drugs, as a source of
information and as a medium of online counselling (www.drogart.org), help and
advice for young people. The site has become very popular between club and




                                        17
                                                The Republic of Slovenia - PART 2
                                                 EPIDEMIOLOGICAL SITUATION


partygoers because of the full coverage and reports from events in Slovenia
and Croatia, DJ interviews and accurate, up to date drug information.

In the year 2000 we are focused on the new synthetic drugs or revival of some
older substances like 2CB and ketamine and on the research of ATS. The
increased amphetamine and methamphetamine use between young people in
Slovenia and EE is our next challenge for prevention. The relatively easy
production of synthetics, transformations in terms of chemical structures and
distribution channels over EE countries as well as low street price of these
drugs is a current reality and a reason for broadened market for synthetic drugs
(and their use between young people) in the near future.


2. Research on ATS in Slovenia (1996 to 2001)

Our knowledge about ATS and dance culture is based from two research
projects dated from 1996 to 1998 (Both research projects were directed by B.
Dekleva – Faculty of Education). First research was about ecstasy users and
the second about drug use in secondary schools in Ljubljana (ESPAD 1998).

The first one was a cross section study using ESPAD-type methodology and
representative sample of Ljubljana‟s 15 years old youngsters. Its main finding is
that ecstasy is the drug which use has grown the most in the last three years. In
1998 7% of our 15 years old sample already used it at least once in their life,
while among pupils of less academically oriented schools the respective
percentage is about 13%. Ecstasy has become the second most frequent illegal
drug (on the question - already used in life), following cannabis. At the same
time - for some percentage of youngsters - it is becoming the first illegal drug
that they have used (instead of marihuana).

The second study used snowball sampling and field interviews with ecstasy and
other dance drugs users. Its aim was to get to know the (sub)cultures of the
users, to estimate their knowledge about dance drugs and the eventual
existence of their own spontaneously learned, shared and used harm reduction
knowledge, techniques and practices. We were also interested in the drug
dealing and using networks, in their relations with other drug using subcultures
and similar issues. We found out that users are mostly interested in “objective”
information on drugs, that they try to minimize harm and feel that there is an
absolute lack of any information on ecstasy and related drugs available for them
(except their own experience and information transferred through peers
networks).

Our last research project The use of amphetamine, methamphetamine and
other synthetic drugs in Slovenia (research project was directed by M. Sande –
Faculty of Education & DrogArt) was oriented towards the use of ATS in the
population of Slovenian partygoers. The goal of the research project was the
evaluation of amphetamine, methamphetamine and MDMA use on rave parties
and to compare the results with the results gained from general population. The



                                       18
                                                 The Republic of Slovenia - PART 2
                                                  EPIDEMIOLOGICAL SITUATION


next goal was to answer the question, whether the use of synthetic drugs in
Slovenia is problematic, harmful and chaotic (the link between the quantity of
consumed drugs, mixing of different drugs and problems detected by users
themselves). The final goal was the evaluation of the connection between the
need for sensation seeking and the use of stimulants and the connection
between lower self-esteem and the use of stimulants.

The results are pointing on high level (86%) in lifetime prevalence of the MDMA
use and relatively high popularity of synthetic drugs (2. MDMA, 3. Cocaine, 4.
Amphetamine1). Methamphetamine is known, but used by the small percentage
of the sample. GHB on the other side is used between 4% of the sample.

The research sample contained 1500 visitors of electronic dance events in
Slovenia. One third of the sample replied on the questionnaire over the Internet,
and two thirds of the sample answered on the same questionnaire which was
distributed on the dance events in Slovenia. We also included a group of
students (non users) to evaluate the role of sensation seeking and self esteem
on the use of drugs. The final results will be presented in June 2001.

The results are displayed as a comparison between special population of
partygoers (Sande, 2000) and ESPAD based School Survey (Stergar, 1999).

Table 2.1.1.    The lifetime prevalence of drug use between partygoers in
                Slovenia

                               Sande 2000         Stergar 1999
Research
                                M=20,3 y            M=15 y
                                  %                   %
Marihuana                         93,8               32,2
Cocaine                           46,7                2,0
Heroin                            25,0                2,2
Ecstasy                           86,0                5,2
Amphetamine                       71,9                1,8
Methamphetamine                    9,8                 /
LSD                               47,1                5,2
Magic Mushrooms                   43,1                 /
GHB                                4,7                 /
Sedatives                         26,8                 /
Ketamine                           2,3                 /
Crack                              3,1                 /

Source: Matej Sande, DrogArt




1 On the question “Which is your favourite drug?” the first drug of choice
remains cannabis.



                                            19
                                                 The Republic of Slovenia - PART 2
                                                  EPIDEMIOLOGICAL SITUATION


Populations using new synthetic drugs seems to be different to the one using
heroin and other opiates/opioids. Thus new strategies will have to be
established.

Drug policy and response is a result of various initiatives evolving from experts,
media, politicians, NGOs, drug users and their relatives. There is a
comprehensive national drug plan or strategy accepted that is prepared by
Governmental Drug Office and the Slovenian policy is unceasingly dependent
on approaches accepted in EU countries. Various international programmes
and projects have been imported in recent years, but we always respected the
specific needs of our populations and society.

In the last few years, in the light of menacing AIDS/HIV epidemic, harm
reduction measures were given priority over approaches aimed to complete
abstinence.
Harm reduction and demand reduction programmes principles have been
widely accepted among different professionals and at different governmental
departments. Increasingly good cooperation has been established between
these sectors.

There are many treatment facilities within the national health care system. Long
term treatment and rehabilitation is limited to the treatment in few therapeutic
communities operating within the country and therapeutic communities abroad.
Methadone maintenance programmes, detoxification and treatment in
psychiatric hospitals are available to all drug users through compulsory health
insurance. Treatment in therapeutic communities have no legal bases to be
financed by health insurance, therefore special funds within the Ministry of
Labour, Family and Social Affairs have been established lately.




                                        20
                                                  The Republic of Slovenia - PART 2
                                                   EPIDEMIOLOGICAL SITUATION



2.2. Drug use in the population


a)   Main results of surveys and studies

In comparison with EU countries, Slovenia was staying approximately ten years
behind in consumption of illicit drugs among the young. Lev Milčinski with his
co-workers, and Dušan Nolimal with co-workers studied the extent of drugs in
Slovenia at the beginning of the 80s and discovered that it was not large.
Research among students in Ljubljana (A. Gosar at all, Medicinski razgledi,
1984) at the beginning of the 80s showed that the widespread of illegal drugs in
that period was not as great as in some western countries in the same period.
The situation became much worse at the end of the 80s, when younger and
younger age groups started to take heroin and certain other prohibited drugs
and began to inject their drugs.

Based on scare literature and observation reports, the following trends can be
observed. From the late 1960s to the mid 70s cannabis, LSD, tranquillisers,
solvents and minor pain relievers were popular, but there was no epidemic of
drug use. After that there was a period of initially increased illicit drug use. In
that period there was limited experimentation with opiates. Injection use was
rare. In the late 70s, small groups of dropouts started to inject opiates more
frequently. Most opiates and opioids were stolen from pharmacies and there
was some home grown opium from the farmers. In the late 80s there was the
increase of the incidence and prevalence of cannabis, followed by considerable
increase in the injection use of heroin.

The police reports also said that at the end of the 80s and at the beginning of
the 90s was discovered a visible increase in the illegal production and sale of
drugs. That was seen also in much larger quantities of seized drugs, especially
heroin; in the increase of criminal offences which the Penal Code defines as
illegal production; in the increased sale of drugs and drugs consuming
permissions as well as other offences, violent acts and secondary crimes linked
with drugs.


The only general survey on the prevalence of drug use among population older
than 18 years is from 1994.


Although a small amount of heroin use was noted in the late 1980s. Use of
heroin first emerged as a considerable problem in Slovenia during the early
1990s. It started to increase in the mid 1990s and expanded rapidly in the
second half of the 1990s.
The quantities of heroin seized in the country have increased dramatically. The
proportion of addicts in prisons charged for heroin offences increased sharply.




                                        21
                                                  The Republic of Slovenia - PART 2
                                                   EPIDEMIOLOGICAL SITUATION



b)   General population

There are presently estimated 5000 -10.000 heroin users in a total population of
two million citizens. But this information is not reliable since it is based on key
actors‟ opinion. The majority of heroin users inject. The first demand for heroin
addiction treatment, as recorded by the majority of treatment centres, rose
rapidly until 1991. Drug injecting is an important risk factor for HIV and hepatitis
infection. The fieldwork and ethnography suggest that the level of HIV risk
behaviours among injection drug users is unacceptably high. This paper also
provides an assessment of the current general drug use situation and status of
epidemiological research in Slovenia, with an emphasis on heroin misuse.
Trends in demand and market indicators are basis for this report. At present,
HIV seroprevalence among treatment populations is low. This merely indicates
that HIV has not yet been introduced into the networks of injection drug users in
Slovenia. Methadone maintenance began in late 1980s and first syringe
exchange started in 1992. Through continuous implementation of harm
reduction approaches aimed at injection drug users it may be possible to
contain an HIV epidemic in the population of heroin users.

Since early 90s a considerable increase in injection drug taking, heroin in
particular, was noticed in Slovenia. More drug-related overdoses were
registered for the first time. The rise in hepatitis C and B among drug users in
treatment centres was observed.

At present HIV seroprevalence among treatment populations is practically non-
existent. This merely indicates that HIV has not been introduced yet into the
networks of IDUs. This should not be taken as a reassurance - when
introduced, the virus could spread like a wildfire.

The seizure of other drugs has also being increased. The trend in the growth of
the amount of confiscated drugs is continuing.

In 1995, the Slovenian police confiscated the first larger quantities of
amphetamines (1302 tablets) and ecstasy (7354 tablets). These are new drugs
previously hardly found on the Slovenian market. They are mainly used in
connection with rave parties and the population of users differs from the one
using heroin. No relevant research about ecstasy use has been published yet.

Epidemiological situation of drug use and dependency in Slovenia is subject to
dynamic changes. However, the most commonly used drugs are still alcohol
and tobacco. On the second place are different medicaments, mainly sedatives,
hypnotics, anxiolitics, analgesics. Most frequently prescribed psychoactive
drugs are benzodiazepins. Smoking of cannabis has become part of the young
people‟s social behavior. No reliable data on the prevalence of drug
consumption in Slovenia is available.




                                        22
                                                        The Republic of Slovenia - PART 2
                                                         EPIDEMIOLOGICAL SITUATION



c)    School and youth population

The ESPAD survey was carried out by the Institute of Public Health of the
Republic of Slovenia in 1995 and in 1999. The data for 1999 and comparisons
1995 –1999 will be presented in this report.


In 1999 the target population consisted of all secondary students in grade 1
born in 1983. It was estimated that about 90% of the age group attended some
kind of secondary education in spring 1999. The majority (83%) were found in
the first grade. There were 170 secondary schools in Slovenia at the beginning
of school year 1998/99. Traditionally, secondary education is offered in four
types of schools: grammar schools, 4-year technical schools, 3-year vocational
schools and 2,5-year vocational schools.


Table 2.2.1.      School survey data, Slovenia, 1999

                                                        last 12 months     last 30 days
                              lifetime prevalence, %
                                                        prevalence, %     prevalence, %
Cannabis                                24,9                21,2              12,8
Heroin                                  2,6
Cocaine                                 1,8
Hallucinogens                           3,0
LSD                                     2,4
Other halluc.
Magical mushroom
                                        1,5
Solvents                                14,5                 7,0               2,7
Hypnotics and sedatives                 7,9
Amphetamines                            1,2
Ecstasy                                 4,1
Anabolic steroids or other
                                        2,3
doping substances

Source: Eva Stergar, Institute for Public Health




                                                   23
                                                                                                                  The Republic of Slovenia - PART 2
                                                                                                                   EPIDEMIOLOGICAL SITUATION


Figure 2.2.2.                                Key Slovenian results, compared to European average, 1999

         100


          90


          80


                                                                                                                                 ALL COUNTRIES
          70
                                                                                                                                 SLOVENIA

          60


          50
    %




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Source: Eva Stergar, Institute for Public Health

The proportions of Slovenian students who had been drinking any alcohol and
had been drunk during the previous 12 months are both very close to the
averages of all ESPAD countries (83% and 56% respectively). The lifetime
prevalence of smoking cigarettes is somewhat lower than the average (64 vs.
69%), as is the 30 days prevalence (29 vs. 37%). The proportion of students
who have used marijuana or hashish is higher than average (25 vs. 16%), while
the use of other illicit drugs is about equal (7%). The use of inhalants is higher
(14%) than average (10%), while the use of tranquillizers or sedatives without a
doctor's prescription as well as alcohol in combination with pills are both very
close to the averages of all countries (8 and 9% respectively).

d)              Specific groups (e.g. conscripts, minorities, workers, arresters,
                prisoners, sex workers, etc.)

        General information about prisoners with drug problems

Among people who have problems with drugs we include long-time drug users
and people who occasionally use drugs. There are also people who started
experimenting with drugs in prison.
We obtain information about people who are dependent on drugs or who
occasionally use drugs on the basis of the documentation accompanying the
person on the path to prison (e.g. court ruling, compulsory treatment measure
imposed on a drug addict, report from the Social Work Centres etc.), but
generally at the beginning of his sentence a drug addict himself discloses his
problem because he is concerned about a withdrawal crisis or because he is on
a methadone therapy.




                                                                                                24
                                                       The Republic of Slovenia - PART 2
                                                        EPIDEMIOLOGICAL SITUATION


Drug problems are presented among all categories of prisoners – remand
prisoners, inmates, people sentenced in a misdemeanour procedure, young
offenders. Most often they are men between the ages of 16 and 49.


Table 2.2.2.     Number of prisoners with drug problems compared to a total
                 prison population

                                    1995       1996    1997     1998     1999     2000
Total prison population             4046       3767    3882     5113     6348     6703
No. Dependent on drugs                  133     156     268      306      471      512
Percentage                              3.28    4.14   6.90     5.98     7.40     7.63

Source: Central Prison Administration



Other problems connected with drugs are illegally bringing drugs into prisons,
dealing in drugs on the black market, taking drugs, a danger of infection from
sharing needles and experimenting with drugs.


2.3. Problem drug use


a)    National and local estimates, trends in prevalence and
      incidence, characteristics of users and groups involved, risk factors,
      possible reasons for trends

Slovenia‟s social economic and political situation is conductive to further
increase of drug use. Increase in drug availability, limited economic
perspectives and the loss of traditional values have contributed to the epidemic
proportions of drug use among the young population. Of course, speculating
about the current extent and future trends of the problem of drug use with
deficient reliable sources of information is not easy task. The individuals who
had a specialized knowledge of or were involved with drug problems stated that
the number of problematic heroin users probably was somewhere between
5000 - 10.000 individuals at risk. These numbers are seemingly still smaller
than in the Western Europe, but not negligible compared to the small size of our
country and the population of two millions. It seems that they have already
reached the level at which the spread of HIV could be facilitated. If HIV would
enter the nets of injection drug users, seroprevalence among these populations
might quickly reach high levels. Also, increasing drug related mortality among
drug injectors heightened the need for more valid information on the level of risk
behaviours.

Before 1989 the drug injecting problem in Slovenia - recognized today as the
main risk behaviour - seemed quite limited and the country had very little



                                               25
                                                 The Republic of Slovenia - PART 2
                                                  EPIDEMIOLOGICAL SITUATION


experience with a response to the drug problems. The problem has become to
be regarded as more serious during recent five years, if the size of such a
problem is determined by the great attention of the mass media and high level
of public concern.

Today the reliable data on the drug use problem are available through the
treatment demand data. In the past we did not have the reliable and
comparable epidemiological data on drug misuse problem. In the beginning of
1990s, i.e. when a large number of young people in Slovenia became involved
in heroin the reporting was non-existent. The reasons for this insufficiency in the
past were a lack of treatment and a lack of research of infrastructure,
specialized knowledge and experiences in addressing drug problems. All these
resulted in the lack of methodological and conceptual clarity of the described
estimation approaches.


Though sharing needles and syringes decreased, many patients are still doing
it. More concerning is the fact that more than half of the treated users were
never tested for HIV infection. These findings require a fast response. Of
course, the data also reflects the quality of data collection.

The prevalence of drug use problem‟s data is still scarce. However, we now
have the reliable information on drug treatment demand. The heroin injectors
are mostly studied through this approach. The majority of heroin users inject.
Most of them are multiple drug users. Some users sniff, smoke the drug in
cigarettes or chase it from an aluminium foil. Drug injecting is an important risk
factor for HIV infection. There is an urgent need for more ethnographic research
to collect necessary information on risk behaviour.

The early attempts in the fieldwork suggest that the level of HIV risk behaviours
among injection drug users (IDUs) is unacceptably high. This suggestion is
corroborated by the high hepatitis C sero-prevalence level in a small treatment
sample.

At present HIV sero-prevalence among treatment populations is practically non-
existent. This merely indicates that HIV has not been introduced yet into the
networks of IDUs. This should not be taken as a reassurance - when
introduced, the virus could spread like a wildfire.


b)   Risk behaviours (injecting, sharing, sex…) and trends

A more detailed insight is provided in Part 4, Chapter 11. Infectious diseases.




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3.     Health Consequences

3.1. Drug treatment demand

The connection between injection drug use and (imminent) epidemics of
infectious diseases among users urges us to reconsider the addiction treatment
and drug abuse control policies in the early and middle 90s. It was concluded
that even if the risks associated with illegal drug use were not entirely
preventable, proper harm-reduction strategies could reduce them considerably.
These approaches have gained increasing support over the last decade, while
more conventional psychiatric approaches have appeared ineffective,
expensive and counterproductive. The drug treatment demands increased
considerably in the period from 1991 to 2001. The Methadone maintenance
programs are the most common exemplars of harm reduction as an approach to
health care of drug users in Slovenia.

The Drug Treatment Demand (DTD) Project and the use of the Pompidou
Group Treatment Demand protocol to collect data on drug treatment demand is
one of the most important projects in the field of drug reporting systems. It also
monitors treatment demand trends. Some additional questions on sexual risk
behavior (numbers of partners, condom use and prostitution - trading sex for
drugs or money), hepatitis infection and criminal behavior were added to the list
of information collected by PG questioner. Also, we collect more detailed
information on injecting risk behavior, including “currently and ever shared other
injecting equipment”.

The DTD Project has worked successfully in the network of the centers for
prevention and treatment of illicit drug use for more than six years. Actually we
started to collect first data on the pilot base in 1991 in the cities of Ljubljana and
Koper. Most of this time we have done our best to improve data quality and
comparability of treatment demand data and to provide annually descriptive
data reports for the different cities and the country. Starting in 2002, the new
PG/EMCDDA questioner on treatment demands has been introduced and the
risk behavior list of questions has been revised. The DTD data on drug users
entering treatment centers for drug addiction represent the basis for planning
activities of these centers. The planners and providers of health care use these
data to identify the types of patients opting for specific activities and to formulate
incentives for the treatment of individual sub-groups. Furthermore, the data
indirectly show the changing patterns of the more problematic drug use among
the population. It is therefore necessary to differentiate between the data on the
users who seek drug-abuse treatment for the first time and those who have
already undergone the treatment. The ratio between first and repeat treatments
is an accurate indicator of drug use incidence. The collected data are also a
useful basis for the research into the efficacy and cost-effectiveness of drug-
abuse treatment.



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Also, this project had a strong impact on our training efforts in drug use
epidemiology and information systems. Therefore the DTD project allowed to
establish a human network that will be maintained with the extension of this
project to other drug treatment facilities.

In the period from 1996 to 2000 drug users most commonly sought treatment
because of the heroin use (92.4% in the year 2000) and because of other drugs
to a considerably lesser extent. Most were male (77.3 %), with a mean age of
24.7 years for male and 22.7 years for female. In recent years the proportion of
cases for stimulant (cocaine, amphetamines), ecstasy and cannabis have
increased, although at low levels. Combinations of illicit drugs, alcohol and
benzodiazepines are common. Injection drug use that prevails among the
treated drug users is associated with a high risk of local infections, necrosis,
breakdown of the circulatory system, generalized septicemia, overdose and
many potentially fatal infectious diseases, such as HIV and hepatitis B and C
infection.
The proportion of treated current injectors (injecting last month) who reportedly
sharing needles and syringes during the month before the treatment demand
has decreased and reached 18.2 % in 1996. After that it has increased up to 30.
4 % in 1998 and went back to 25.8 % and 28.1 % in 1999 and 2000
respectively. However, no upward trends in reported HIV incidence rates and
HIV prevalence among treated drug users have been observed.
In the period from 1996 to 2000 the prevalence of HIV infection has consistently
remained below 1% among the tested drug users. During the same period the
prevalence of HBV detected among drug users demanding treatment for the
first time ranged from 0 to 3% and the prevalence of HCV was between 9 to 13
% (for data for injecting drug users only see the “information on the prevalence
oh HIV, HCV and HBV among injection drug users”).

The coordinator always checks individually reported data variable by variable.
Data check routines and internal consistency checks were developed (together
with the PG experts). The comments and reactions about unclear information
are exchanged by phone or mail. This process allows better data quality in
reporting. It serves as a training opportunity as well.
Of course there is a limitation of this sort of surveillance, regarding validity of
self-reported information. There are also missing values on some variables. But
during the course of the project the data quality improved remarkably.
Up till now the analyses of drug use, injecting risk behavior and sexual risk
behavior trends (e.g. development of heroin use in the reduction of injecting,
needle sharing and condom use behaviors, introduction of new drugs on the
scene, the prevalence of HIV and hepatitis etc.) were the most challenging
outcomes of this project. The trend analyses of TD data, combined with
information from qualitative research will be the most important task in the
future. Since the questionnaire has been revised in 2002, additional guidelines
will be developed.




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Figure 3.1.1.         Drug treatment demand, Slovenia, 2000 (N=946)

Treatment contact               All         First Socio–demographic                 All         First
Details                 treatments    treatments information                treatments    treatments
No. of                         946          377 Male                            77,3 %        77,4 %
cases/demands
Coverage estimation                              Age < 20 years                18,3 %        34,5 %

Double counting                yes          yes Age 30 years and more            14 %          6,6 %
controlled
Never treated               39,9 %       100 % Mean age                           24,3            22

Self referral               91,4 %       91,7 % Current living status –        70,2 %        78,7 %
                                                with parents
Problem drug use                                Current living status –        15,1 %          9,3 %
                                                with partner
Primary drug heroin         92,4 %       84,6 % Regular employment             26,7 %        19,4 %

Primary drug cocaine         0,8 %       1,06 % Never completed                  4,8 %         3,7 %
                                                primary school
Injecting (heroin,          75,9 %       64,5 % Higher level of                   2%           1,6 %
opiates)                                        education
Smoke (heroin,              14,2 %       27,5 % Risk behaviour vedenje
opiates)
Primary drug use            49,7 %       64,2 % Currently injecting (last      56,4 %        61,3 %
daily                                           month)
Primary drug use -           6,2 %        8,2 % If injecting, shared past      11,3 %        13,5 %
age <15 years                                   month
Mean age of primary           18,9         18,6 Ever injected                  83,8 %        72,1 %
drug use
                                                 If ever injected, ever        47,5 %        35,3 %
                                                 shared
                                                 First injecting age < 20      42,9 %        39,8 %
                                                 years
                                                 Mean age of first                20,2          20,1
                                                 injecting
                                                 HIV tested – positive           0,2 %              -

                                                 Never tested for HIV          42,3 %        74,5 %



Source: Nolimal D., Vegnuti M., Belec M., Institute of Public Health of the Republic of Slovenia
in collaboration with 16 outpatient drug treatment centres, April, 2001




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3.2. Drug-related mortality

We would like to stress out that there are no uniform national data
according to EMCDDA methodology in the Republic of Slovenia. But some
data are available, anyway.

Accoding to a research of Majda Zorec Karlovšek PhD, Institute for Forensic
Medicine, Medical Faculty, University of Ljubljana, in the year 2000 29 drug
related deaths are noticed in Slovenia, all associated with the use of opioides.
In 20 cases a drug overdose was detected as a direct drug related death
(heroin, methadone, tramadol and their combinations with ethanol and
benzodiazepines), in 9 cases as an indirect drug related death. Heroin or the
analyte morfine was detected in 15 cases (51,8%).

The number of all drug related deaths is higher than in the year 1999 for
the ratio 1,2. The ratio for the year 1998 is 1,45. In the year 2000 is also
interesting the rise in the number of indirect drug related death
(suicides of addicted people) to the year 1999 for the ratio 9:4=2,25.

The Reports from the toxicological department of the Institute of Forensic
Medicine are based on the number of requests for toxicological analyses in the
cases of drug related deaths.


Data collection on deaths due to illegal drugs use has no uniformly prescribed
methodology – direct comparison are difficult.
But we started with activities for preparation data base on mortality according to
EMCCDA guidelines.

According to a research, done in the Institute of Public Health some data are
available:




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Figure 3.2.2.              Mortality rate per 100.000 population by age groups and gender
                           (Slovenia 1985 -2000)

      5


     4.5
                     Women
                     Men
      4


     3.5


      3


     2.5


      2


     1.5


      1


     0.5


      0
           1985    1986    1987     1988     1989    1990    1991   1992    1993   1994    1995     1996     1997    1998    1999     2000




Source: Jožica Šelb, Institute of Public Health

Figure 3.2.3.              Mortality rate due to drug use population for population aged 15
                           to 49 by gender (1985 -2000)

     2.5


                                                                                                                            W omen
                                                                                                                            Men
       2




     1.5




       1




     0.5




       0
           15-19   20-24    25-29    30-34      35      39     40-44   45-49   50-54    55-59     60-64    65-69    70-74   75-79    80-84




Source: Jožica Šelb, Institute of Public Health




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Figure 3.2.4.      Mortality rate due to drug use by birth cohort (1985 -1999)

       3
                     Born   1960-64
                     Born   1965-69
                     Born   1970-74
     2.5             Born   1975-79
                     Born   1980-84


       2



     1.5



       1



     0.5



       0
                    1985-89                       1990-94                1995-1999



Source: Jožica Šelb, Institute of Public Health




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3.3. Drug-related infectious diseases

A more detailed insight is provided in Part 4, Chapter 11. Infectious diseases

HIV and AIDS

Slovenia has a low level HIV epidemic. In 2001 the reported newly diagnosed
HIV incidence rate was 8.0 per million (one case injecting drug user - IDU) and
reported aids rate 2.5 per million (no IDU cases). According to all available HIV
surveillance information the prevalence of HIV infection among injecting drug
users in Slovenia remains below 1%. Regretfully, all HIV prevalence information
is limited to treatment data and no information is available from needle
exchange, other lower threshold harm reduction programmes or from
community based surveys.

HBV

In 2001 reported acute HBV infection incidence rate in the Slovenian population
was 0.9 / 100.000 population, which underestimates the burden of the disease.
Since information on transmission route was not available it was impossible to
estimate the proportion of injection drug users. During the period from 1996 to
2000 the prevalence of antibodies against hepatitis B virus (HBV) among
confidentially tested injection drug users treated in the network of Centres for
Prevention and Treatment of Illicit Drug Use ranged between 2.6% to 6.6%. All
available HBV prevalence information is limited to treatment data.

HCV

In 2001 reported acute HCV infection incidence rate in the Slovenian population
was 0.5 / 100.000 population, which greatly underestimates the burden of the
disease. Information on transmission route was available for six cases of the
total of 10 reported cases. Four cases were among injection drug users. During
the period from 1996 to 2000 the prevalence of antibodies against hepatitis C
virus (HCV) among confidentially tested injection drug users treated in the
primary health care network of Centres for Prevention and Treatment of Illicit
Drug Use ranged between 20.8% to 30.1%. All HCV prevalence information is
limited to treatment data.




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3.4. Other drug-related morbidity

a)   Non-fatal drug emergencies

The toxicological laboratory has started with the study of drugs prevalence in
fatality.


b)   Psychiatric co-morbidity

According to the study "An eight year naturalistic observational study of heroin-
addicted, methadone maintained psychiatric patients" (Lovrečič, Center for
Treatment of Drug Adicts Koper and Maremmani, PISA-SIA Group) dually
diagnosed patients need a higher stabilization dosage (highest dosage
maintained for a minimum of one month), as high as 150 mg/day, than patients
with no additional diagnosis who on the average become stabilized on 120
mg/day. This difference is statistically significant. The higher stabilization
dosage range (80-120mg/day) needed for dually diagnosed patients suggests
that unresponsiveness to standard treatment observed in this category may
actually be due to under medication. The need for such high dosages may
derive from pharmacocynetic issues, since the psychotropic drug dosages
needed to treat this category of patients are also higher than average.

The time needed to reach stabilization is as long as 6 months for patients
without dual diagnosis (min max), whereas dually diagnosed patients require as
long as 14 months on the average to reach stabilization. On the whole, dually
diagnosed patients needed higher stabilization dosage and a longer time to
reach it; the latter factor is not exclusively due just to higher dosages.
Therefore, greater care is recommended for such subjects during the
stabilization phase; dose adjustment may be required even after some years of
ongoing treatment.

The PISA-SIA Group is an operational unit of the Department of Psychiatry,
University of Pisa, Italy. It comprises a hospital division, a Day Hospital and an
Outpatient Unit. The Outpatient Service runs a programme of methadone
maintenance designed to meet the needs of two types of patients.
The first type of patients comprises those who fail to respond favourable to
standard protocols (methadone dosages are generally in the 60-80 mg/day
range, with the maximum of 100 mg/day). In the PISA-MMTP are no dosage
limits and patients are encouraged to accept an increase of their dosage if they
continue to show addictive behaviour. They are referred to public services that
treat addiction and operate on a territorial basis.
The second type of patients comprise of heroin-addicted psychiatric patients
who are resistant to standard psycho-pharmacotherapy. These patients do not
remain compliant with pharmacological treatment; once they have left the
hospital they usually discontinue the treatment and show psychopathological
symptoms and addictive behaviours despite the number of admissions to



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hospital (at least two in the previous two years). After referral by the hospital
division of the Department, they receive methadone maintenance treatment as
soon as they leave hospital.

Data emerging from our naturalistic study make it possible to identify another
subgroup of heroin addicts who should be started on methadone as a priority.
A third or a half of all opiate addicts may suffer from mental disorders.
Enrolment in treatment makes a significant positive impact on their
psychological well-being.
Methadone maintenance reduces maladaptive behaviors (likelihood of overdose
and law-breaking); it is effective on the risk behaviors of pregnant addicts, with
worthwhile benefits for both, the mother and the fetus; it is effective on risk-
behaviours in HIV-infected addicts. Our data shows that even those mentally ill
heroin addicts who have proved to be resistant to treatments, both for addiction
and mental illnesses, and are non-compliant with psycho-pharmacotherapy are
likely to develop an adaptive behaviour as long as they are maintained on an
adequate methadone programme. Thus both, compliance with the treatment of
addiction and the possible treatment of the concomitant mental illness, become
achievable aims.
Therefore, even in dually diagnosed patients methadone maintenance confirms
its power to reverse maladaptive behaviours.


c)   Other important health consequences (e.g. drugs and driving,
     acute and chronic drug effects...)


According to the article Drugs and traffic safety – slovenian aproach (Majda
Zorec Karlovsek, Borut Stefanič)

The Institute of forensic medicine in Ljubljana performs toxicological analysis of
blood and urine samples taken from traffic participants apprehended due to
suspicion of alcohol and drugs. Retrospective study of requests for toxicological
analysis gets the insight in growing problem of drugged driving in Slovenia. The
activities of institute in this field are directed also in the law enforcement,
education, epidemiological research and prevention issues.




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Table 3.4.1.      The number of requests for toxicological analysis in cases of
                  suspicion of drug impaired driving

                    Police controls   Traffic accidents                                      Ratio
Year                                                                             All
                              (PC)                 (TA)                                     PC/TA
1991                             3                       3                     6              1.00
1992                             3                       9                    12              0.33
1993                             4                       3                     7              1.33
1994                            13                      27                    40              0.48
1995                            42                      23                    65              1.82
1996                            73                      35                   108              2.09
1997                           155                      69                   224              2.25
1998                           206                      99                   305              3.08
1999                           516                     166                   682              3.11
2000                           667                     221                   888              3.02

Source: Majda Zorec Karlovšek, Borut Stefanič, Institute of Forensic Medicine, Faculty of
Medicine



Average age among drivers in the accident group was 27.5 years for males and
29.3 years for females and in the non-accident group 24.9 years for males and
25.3 years for females.


Table 3.4.2.      Frequency at which drugs were encountered

                                                                                             All
                                Police controls              Traffic accidents
                                                                                       (n=1307)
Benzodiazepines                         14.2%                          31.6%                17.5%
Opiates                                 19.7%                          24.0%                28.6%
Cannabinoids                            66.2%                          38.0%                60.8%
Cocaine                                  8.7%                           5.2%                 8.0%
Methadone                               26.6%                          25.6%                26.4%
Amphetamines                            11.5%                           8.0%                10.9%
Others                                   4.0%                          18.0%                 6.7%

Source: Majda Zorec Karlovšek, Borut Stefanič, Institute of Forensic Medicine, Faculty of
Medicine




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Health conditions and driving ability of special groups of drivers

During the Slovenian symposium on traffic medicine held in may 1998 in
Rogaška Slatina several conclusions and recommendations concerning health
conditions of traffic participants are given.
It is obvious that a special regulation is necessary for drug rehabilitation
programmes, methadone substitution programme and driving ability.
To the problem of drivers attending methadone maintenance programme a
special conference was performed in June 2001, organised by the Government
Office on Drugs and the Institute of Forensic Medicine.




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4.     Social and Legal Correlates and Consequences

4.1. Social problems

a)   Social problems - social exclusion

The basic starting points for the treatment of difficulties related to illicit drug use
in the social care system are defined in the National Social Care Programme
until 2005 (Official gazette RS 31/2000).
The goals stated in the proposal of the National Social Care Programme which
shall be ensured by the social care system and indirectly by the network of
providers of services and programmes for the treatment of social issues related
to illicit drug use are as follows:
    Improvement of the quality of living,
    Assurance of active forms of social care,
    Development of expert networks of social assistance,
    Establishment and development of the plurality of the activity,
    Design of new approaches to the management of social hardships.

The drug use in the social care system is treated as one of the many behaviour
patterns which may lead to the decreased level of social inclusion of a drug user
or persons who are close to him/her. The fact is that the drug use presents the
behavioural and relational pattern on the basis of which the variety of responses
to everyday-life challenges might be limited. Thus in the very last stage of the
social career of a drug user - the stage of addiction - the majority of important
vital questions are solved by strategies related to the drug use.
With the intention of preventing and eliminating social exclusion which results
from or occurs simultaneously with the use of illicit drugs, the ministry assures
conditions for the operation of expert services which function within the
framework of public services as well as within the framework of activities which
complement the offer of public services and activities of mutual help of drug
users, persons who are close to them or other interested persons.
In social care, the professional support to drug users and persons who are
close to them is directed to the development of individuals and groups in order
to control to the highest possible extent the course of their lives in accordance
with their own ideas, visions and strengths. Processes and methods of
assistance in social care are intended to stimulate the integration processes, i.e.
the processes that enable the social inclusion of individuals and groups into a
broader social context. Social care engages in the prevention and elimination of
conditions and actions of individuals and groups that cause their social
exclusion (excommunication, marginalization, incapacity of exerting influence,
etc.).

A part of the social context used by the individual when solving his/her own
social hardship also consists of various institutions in various fields. When a



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person in hardship, with regard to the nature of the hardship, properly contacts
these institutions with the request for help, this is just a one more piece of
evidence that this person is "properly" socially integrated. This is another
reason why it is so important that a part of the social care system is composed
by providers of public service of social care, with an as evident and
standardised offer of professional support as possible. Providers of public
service are holders of already established and operationalised professional
treatments. The network of providers which complements the offer of public
services shall try to even more specify the needs of its users and to even more
include them into the planning of the activity intended for them. They enable an
even higher level of (re)organisation of implemented programmes in
accordance with specific problems of users.

Currently, the providers of social care services within the framework of public
service are social care institutions - social work centres (altogether 62 of them)
which provide social care services for drug users and persons who are close to
them, particularly the first social assistance, personal assistance and assistance
to the family at home. Public institutions are financed directly from the state
budget for the services of the first social assistance and from the municipal
budgets for the service of personal assistance.

Providers of programmes which complement the offer of public service are
selected by regular annual tenders. Thus in 2000 thirty organisations were co-
financed in the total amount of 6,300,000 SIT (28 125 EUR) and in public
institutions (social work centres, there are 62 of them in Slovenia) 834
individuals were treated whose fundamental problem was related to the illicit
drug use. In the same year 496 of them were treated for the first time.




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4.2. Drug offences and drug-related crime
Description of legislation defines misdemeanours and criminal offences


   Production of and Trade in Illicit Drugs Act:

Article 33 defines:

“Individuals shall be liable to a monetary fine of between SIT 50,000 (EUR 230)
and SIT 150,000 (690 EUR) or a prison sentence of up to 30 days for
committing the offence of possessing illicit drugs in contravention of the
provisions of this Act.

Individuals shall be liable to a monetary fine of between SIT 10,000 (40 EUR)
and SIT 50,000 (EUR 230) or a prison sentence of up to 5 days for committing
the offence of possessing a smaller quantity of illicit drugs for one-off personal
use.

In accordance with the provisions of the Misdemeanours Act, persons who
commit the offence specified in the first paragraph of this article and who
possess a smaller quantity of illicit drugs for one-off personal use and persons
who commit the offence specified in the preceding paragraph may be subject to
more lenient punishment if they voluntarily enter the programme of treatment for
illicit drug users or social security programmes approved by the Health Council
or Council for Drugs.”

Article 34 defines:

“Illicit drugs shall be confiscated from the perpetrator of a violation under this
Act without any monetary compensation, irrespective of whether the illicit drugs
were the property of the perpetrator or whether they were only in the
perpetrator‟s possession.”

   Penal Code of the Republic of Slovenia:

Article 196: Unlawful Manufacture and Trade of Narcotic Drugs

“(1) Whoever unlawfully manufactures, processes, sells or offers for sale
substances and preparations recognised to be narcotic drugs, or whoever
purchases, keeps or transports such substances or preparations with a view to
reselling them, or whoever serves as an agent in the sale or purchase of the
above shall be sentenced to imprisonment for not less than one and not more
than ten years.
(2) If the offence under the preceding paragraph has been committed by at least
two persons who colluded with the intention of committing such offences, or if




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                                                The Republic of Slovenia - PART 2
                                                 EPIDEMIOLOGICAL SITUATION


the perpetrator has established a network of dealers and middlemen, the
perpetrator shall be sentence to imprisonment for not less than three years.
(3) Whoever without authorisation manufactures, purchases, possesses or
furnishes other persons with the equipment, material or substances which are,
to his knowledge, intended for the manufacture of drugs shall be sentenced to
imprisonment for not less than six months and not more than five years.
(4) Narcotics and the means of their manufacture shall be seized.”

Article 197: Rendering Opportunity for Consumption of Narcotic Drugs

“(1) Whoever solicits another person to use a drug or provides a person with
drugs to be used by him or by a third person, or whoever provides a person with
a place or other facility for the use of drugs shall be sentenced to imprisonment
for not less than three months and not more than five years.
(2) If the offence under the preceding paragraph is committed against a minor,
the perpetrator shall be sentenced to imprisonment for not less than one and
not more than ten years.
(3) Narcotics and the tools for their consumption shall be seized.”


Criminal offences and Misdemeanours

Similarly as in the previous years also in 2000 an increase was registered in the
number of the discovered criminal offences and suspects as well as in the
seized quantities of illicit drugs and the discovered offences due to the illegal
possession of illicit drugs.
InIn comparison with 1999, the number of criminal offences increased by 22.2
%.
The increase was also registered in the number of discovered suspects against
whom criminal information was provided. The number of discovered offences of
illegal possession of illicit drugs also increased by 34 %.

It may also be established that there was an increase in the number of persons
who were detained due to the suspicion of having committed a criminal offence
in the field of illicit drugs. For this reason in 2000 a 78.9 % increase in the
number of detained persons was registered.

The internal structure of the discovered criminal offences shows that there
prevail criminal offences pursuant to Article 196 of the Penal Code of the
Republic of Slovenia. It is necessary to mention that the increased total number
of discovered criminal offences is predominantly a consequence of the
increased number of discovered criminal offences pursuant to Article 196 of the
Penal Code of the Republic of Slovenia, since the number of such offences
increased by 25.9 %, while the number of discovered criminal offences due to
enabling the consumption of drugs pursuant to Article 197 only increased by
14.9 % which is less than the average value amounting to 22.2 %.




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Table 4.2.1.      Number of Criminal offences and Misdemeanours

Illicit Drugs                        Criminal offences       Misdemeanours                Together

Heroin                                                148                 404                 552
Cocain                                                 25                  70                  95
Ecstasy                                                31                 117                 148
Amphetamine                                            11                  47                  58
Canabis (plant)                                        47                 379                 426
Canabis (marihuana)                                   309               3.643                3952
Canabis resin (hashish)                                 6                  54                  60
Lsd                                                     0                   0                   0
Methadone                                              15                  43                  58
Benzodiazepines                                         2                  17                  19
Together                                              594                4774                5368

Source: Ministry of Interior

Table 4.2.2.      Number of Criminal offences and Misdemeanours
                  from 1991 to 2001

                        1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
Criminal offences       202    264   281   407        453   675   964   988     1121 1370 1537
Suspects                210    325   329   475        539   752   1072 1168 1241 1568 1681
Misdemeanours           135    205   365   418        796   1174 1773 1954 2289 3433 4352
No. of deaths           5      9     9     4          12    16    16    18      19   12     18

Source: Ministry of Interior




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Figure 4.2.1.       Number of Criminal offences and Misdemeanours


      4000
      3600
      3200
      2800
      2400
      2000
      1600
      1200
       800
       400
         0
             1991    1992      1993      1994      1995    1996       1997     1998    1999   2000   2001

                                      criminal offences    suspects          misdemeanours


Source: Ministry of Interior




4.3. Social and economic costs of drug consumption
There are no studies and assessments of social costs caused by the drug use
yet. We are also not able to estimate the consumption, demand and resources
spent for drugs.




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5.      Drug markets

5.1. Availability and supply

According to our estimation, Slovenia is one of the countries with a high level of
presence and abuse of illicit drugs, of illegal traffic in illicit drugs and of the
operation of organized criminal groups. This situation also results from the
particular influence by the nearby economically unstable regions after the
normalization of the situation in the Balkan area. All this gives a special
character to the imperilled situation of our country in the field of safety, which is
directly and indirectly related to the issue of illicit drugs.


5.2.     Seizures

Trends in quantities and numbers of seizures

Figure 5.2.1.       Numbers of seizures of heroin


       400
       350
       300
       250
       200
       150
       100
        50
         0
             1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

                                          HEROIN kg
Source: Ministry of Interior




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Figure 5.2.2.       Numbers of seizures of ecstasy and cannabis unit


        50000
        45000
        40000
        35000
        30000
        25000
        20000
        15000
        10000
         5000
            0
                  1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

                                 ECSTASY tableta         KANABIS (bilka) kos


Source: Ministry of Interior


Figure 5.2.3.       Numbers of seizures of cannabis




        3000

        2000

        1000

            0
             91

                    92

                            93

                                   94

                                          95

                                                 96

                                                        97

                                                               98

                                                                      99

                                                                             00

                                                                                    01
           19

                  19

                          19

                                 19

                                        19

                                               19

                                                      19

                                                             19

                                                                    19

                                                                           20

                                                                                  20




                                        KANABIS (marihuana) kg


Source: Ministry of Interior




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Table 5.2.2.      Seizures of illicit drugs

                                                                             Increase
ILLICIT DRUG                          UNIT             2000       2001
                                                                          Decrease %
HEROIN                                kg             392,65       88,93         -77,4
COCAIN                                kg               0,98        1,08          10,2
ECSTASY                               tablets        27.928       1.852         -93,4
AMPHETAMIN                            kg                0,2        0,06         -70,0
                                      tablets           309         89          -71,2
CANABIS (plant)                       piece           3.354       1.925         -42,6
                                      kg                6,1        2,78         -54,4
CANABIS (marihuana)                   kg           3.413,24       175,1         -94,9
CANABISC RESIN (hashish)              kg               1,22        2,36          93,4
LSD                                   piece              59           0        -100,0
METHADON                              tablets           245        382           55,9
                                      Ml              1,545       3,346        116,6
BENZODIAZEPINE                        tablets           735        460          -37,4
Anhydryd Acetic acid                  kg              9.900      10.000           1,0

Source: Ministry of Interior



5.3. Price/purity
Some data on price are available in standard table 16: “Price at street level of
some illegal substances”.

Some data on purity are available in standard table 14: “Purity at street level of
some illegal substances”.




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6.     Trends per Drug

Comparable data on drug use are rare, but according to available researches
and collected data in different sectors, we can conclude that in Slovenia we
have been observing considerable increase in drug consumption, heroin in
particular, since 1990.

New synthetic drugs are becoming more and more popular among young and
are related to the techno subculture. School surveys pointed at constantly falling
age of drug abusers.
Drug related deaths are increasing.
Risk behaviour among injecting drug users is of special concern according to
the rise in hepatitis C and B infection in this population. However, HIV epidemic
has not yet been observed in this group.

At the policy level the tendency towards more structuring and networking has
been noted, especially in sector and educational social.

Heroin use was reported to be increasing in the 1990s. Surveys estimated that
there were some 1500 – 3000 users (75 – 150 per 100 000 population) in the
mid-1990s, increasing to 5000 (250/100 000) in 1997. Overall, 2% of school
children reported having used heroin in a high school survey performed in 1992
(WHO Regional Office for Europe, 1997).

The use of amphetamines, LSD and cocaine has also increase. Multiple drug
use (including alcohol) is common. A high school survey in Ljubljana reported
that 4.8% had used LSD, 4.5% tranquillisers and other pills, 1.6% glue and
0.8% cocaine (WHO Regional Office for Europe, 1997).

According to a ESPAD-survey (European School Survey Report on alcohol and
other drug use among 15 to 16-year-old) performed in 1995 and 1999, for the
use of all illicit drugs in a lifetime, nearly three-fourths of the surveyed students
in 1999 (74.4%) said they had never used any of the listed substances i.e.
marijuana, amphetamines, LSD or other hallucinogenic drugs, crack, cocaine,
ecstasy or heroin. Using any of these illicit drugs once to 5 times was reported
by 12.8% of the respondents. Slightly less than 3% had used these substances
6 to 9 times, 10 to 19 times or 20 to 39 times in their lives, and 6.5%
acknowledged the use of illicit drugs 40 times or more.

Marijuana use was denied by 76% of the surveyed. Of those who had tried it,
3% had done so at age 12 or earlier, 12% at age 13, 35% at age 14 and as
many as 45% at age 15.
There were statistically significant gender differences concerning the age at first
use of marijuana. A higher proportion of girls than boys said they had never
smoked marijuana.




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Overall average annually reported newly diagnosed HIV incidence rate during
last five years (1997 to 2001) has been 6.5 per million population (8.0 per
million in 2001). Average annually reported aids rate has been 3.5 per million
population (2.5 per million in 2001). The prevalence of HIV infection has not
reached 5% in any population group, not even in the most affected group of
men who have sex with men.
According to all available information the prevalence of HIV infection among
injecting drug users in Slovenia remains low.

During last 10 years (1992 to 2001) the reported newly diagnosed acute HBV
infection incidence rate in the Slovenian population decreased from 4.5 /
100.000 population in 1992 to 1.0 / 100.000 population in 2001. Due to
underreporting, HBV reported incidence rates greatly underestimate the burden
of the disease.
Nevertheless, the downward trend should be noted. For the period from 1997 to
2001 information on transmission route is available for a minority of cases.
Injecting drug use was implicated in 0% to 25% of those cases.

During the period from 1996 to 2000 the prevalence of antibodies against
hepatitis C virus (HCV) among confidentially tested injecting drug users treated
in the primary health care network of Centres for Prevention and Treatment of
Illicit Drug Use ranged between 20.8% to 30.1% (30.1% in 1996, 21.1% in
1997, 20.1% in 1998, 21.2% in 1999 and 20.8% in 2000).

In the period from 1996 to 2000 drug users most commonly sought treatment
because of the heroin use (92.4% in the year 2000) and to a considerably
lesser extent, because of other drugs. Most were male ( 77.3 %), with a mean
age of 24.7 years for male and 22.7 years for female.
The trend analyses of TD data, combined with information from qualitative
research will be the most important task in future.

Drug problems are present among all categories of prisoners – remand
prisoners, inmates, people sentenced in a misdemeanour procedure, young
offenders.




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7.    Conclusions

No analysis of the relationship between different indicators, based on the
scientific approach, have been published.

For the policy planning to be based on relevant research data more quality
research should be introduced. The implementation of the reporting system on
treatment and care (FTD and TD in particular) and mortality at the national level
should be one of the future priorities as are the analysis of the relationships
between different indicators. A prevalence study in general population should
also be one of priorities. There is also a need for more qualitataive information
on the risk behaviour and psychosocial and cultural context of drug use in
Slovenia.

The uniform methodology of collecting and analysing the data will provide the
basis for the comparison of our data with other European countries and the
world, the basis to follow the trends and to evaluate the accepted measures.
That will help us in preparation of the proposals for various activities for the
prevention and reduction of illicit drug use.




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                The Republic of Slovenia - PART 3
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    PART 3

DEMAND REDUCTION
  INTERVENTIONS




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8.     Strategies in Demand Reduction at National Level

Description of national framework of demand reduction emphasising new trend
and developments at organisational level:

In Slovenia we are developing a modern and holistic approach in the field of Drug
Demand Reduction. All relevant legal recommendations from international
organisations like UN and EU are included in those attempts. As recognition of
importance of drug problem in the modern Slovene society, the Government has
established an Office with the task to prepare a New Drug Programme and to
coordinate different policies led by several ministries with the responsibilities in
this area. The highest coordination body in the country is Inter-ministerial
Commission on Drugs. In this Commission the members are seven ministries
from respective Ministrys and seven more experts from different drug fields. The
Governmental Office carries all concrete activities on this level. On the local level
DDR activities are coordinated by the Local Action Groups. Their location is the
most often at the Major Office.


8.1. Major strategies and activities

Synthetic description of major national strategies in demand reduction and new
developments:

Slovenia developed the first National Drug Programme in 1992. In the year 2000
activities for the new Drug Programme has started. Based on an integral,
balanced, multidisciplinary and a global approach the first draft version of the New
Drug Strategy was discussed in the mid February among the junior and senior
policy makers. It is planned that the final version is going to be send to the
Government by the mid of April. After the discussion in the Government, National
Assembly will start with the first reading.

Through an extensive international cooperation with international organisations
such as EU - PHARE Programme, UNDCP, WHO, Council of Europe/Pompidou
Group, Interpol, DEA etc. Slovenia has gained variety of information and
technical assistance that has assisted different actors in field of DDR.
Slovenia has adopted a national drug control policy and consistent demand
reduction strategies. DDR infrastructure can be regarded as developed and with
the crucial instruments in place if not fully deployed. A great variety of
programmes, projects and initiatives have been adapted to our specific needs.

Although core components of a coherent and consistent DDR policy have
already been adopted, the Government (as represented by Governmental office
for Drugs and ministries at the core of DDR) has expressed concern about the




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drug abuse problem and a willingness to further promote DDR programmes.
Several attempts are being made to further enhance the DDR instruments.

The current national respect of policy, strategies and component-wise
implementation of DDR in general may be viewed as promising if not yet
adequate to meet the challenge.

In respect of awareness, treatment, rehabilitation, social re-integration, NGOs
and community involvement - though quite a few programmes seem promising -
further development and effective strengthening is needed, should the entire
DDR sector attain international standards.

Slovenia is able to expand and strengthen its DDR on its own and/or is also
capable to acquire any missing skills if desired. Augmented collaboration
between major protagonists would further accelerate this process. Provision of
limited high-level target-oriented international cooperation would facilitate the
process of further developing the DDR sector.


Structural framework

At the national level DDR activities are coordinated by the Governmental Office
for Drugs which response to the drug problem. A Phare National Coordinator
and a Phare DDR Coordinator have been appointed and are members of the
Governmental Office for Drugs.

The local governments (in major cities) are involved in DDR and participate in
Local Action Groups, provide premises, staff and budget. Municipalities support
specialised institutions and organisations dealing with prevention. The city of
Ljubljana is particularly active in this aspect. The Drug prevention Office of the
Ljubljana City with its task to coordinate among all subjects dealing with drug
problem at the city level is an extremely active body at the local level.
Ljubljana faces an advanced drug abuse situation. Correspondingly, most
services available in Slovenia are represented in its capital city.

A few major cities have formed a Local Action Group, initiating systematic
collaboration between various institutions and professionals at the community
level. This is a particularly positive development.

The full incorporation of NGOs in DDR is not yet achieved. In line with the level
of DDR structure, programmes and services available in Slovenia, up to 10
NGOs are involved directly with DDR. The Government via the Ministry of
Labour, Family and Social Affairs and the Ministry of Health provides a budget
for NGOs, primarily in support of prevention and rehabilitation programmes
(encompassing parents support groups). NGOs also work in health promotion,
provide positive alternatives, drug education, they offer drug hot lines etc.

There are several NGOs which include drug issues amongst their objectives.



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Overall NGOs, in particular those exposed to international contacts, seem to act
professionally. Staff seems to be among the professionals who know a lot about
DDR. For certain activities NGOs tend to rely on and employ professional staff
(medical personnel, psychologists, social workers etc.). Some drug specialised
NGOs depend on volunteers (in particular in parents self-help groups).

Among the leading members/advisors of some specialised NGOs are present
(or former) GOs officials/professionals. NGOs depend on GOs budget and the
GOs do not fully rely yet on NGOs efforts.

The Ministry of Labour, Family and Social Affairs uses parts of its budget for
commissioning DDR to NGOs at the national level.
Presently, it accepts and supports prevention and rehabilitation programs
proposed by some NGOs.

Regular cooperation exists with quite a few international NGOs through which
they have acquired considerable know-how and achieved transfer of knowledge
and expertise.

In the past year Non Governmental Organisations have established the
Association of Drugs NGO with several tasks. The most important one should
be to become a relevant, competent and respected partner to the Government
in all the relevant matters.


8.2. Approaches and new developments

Since 90s harm reduction approaches have gained acceptance and support
among professionals and in public in Slovenia. The first Needle Exchange
Programme has started back in 1992, but even before that variety of activities
was carried out for a promotion of Harm Reduction. Methadone maintenance
and needle exchange programmes are part of national strategy for the
prevention of HIV and hepatitis infections. Drug addiction is defined as a
disease within a psycho-social context and it is seldom that drug addicts are
viewed as criminals in public and in the media. For the last few years harm
reduction approaches have been given priority over the abstinence-orientated
approaches. Preventive vaccination against Hepatitis B is a part of a treatment
for those included in the Methadone Maintenance Programme.

Primary prevention has not been given enough priority and the adjustments of
strategies would be required. Primary prevention should be targeted within
education and should centre on the general awareness creation and health
promotion. At this stage it should be directed at the decision makers and
professionals and more broadly extended to the wider civil society. Prevention
should also highlight a provision of positive alternatives and interventions
appropriate to a young (abuser) generation. Overall, the domination of DDR



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from the health sector should give way to a more multi-disciplinary global
approach. All above-mentioned has been discussed and endorsed into the new
Drug Strategy.

The involvement and support of (specialised and non-specialised) NGOs needs
to be enhanced and that of the local communities further promoted.

In general, as a prerequisite to sound and realistic DDR, political and public
awareness and the attitude of the decision makers and civil society might
require some re-alignment in regard of what constitutes »drugs« and »abuse«.
The stigma associated with drug users needs to be further addressed.

Governmental Office for Drugs has organised or participated in several training
activities in the field of DDR. Networks in the prison, social welfare and NGO‟s are
supported by this agency. All relevant information are published and available on-
line.
Different research activities were financially supported by the Office and findings
disseminated to the broadest audience.




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9.    Intervention Areas

9.1. Primary prevention

9.1.1. Infancy and Family

a) Intervention in different fields:
           - During pregnancy/for future parents
Pregnant drug users have possibility to be counselled and followed during
pregnancy by their physician. There is also a booklet with relevant information
for them.
Existing prenatal health education programmes do not offer information
regarding drug use and how it affects health of mother and child.
           - Aiming at young parents
           - Aiming at the families with adolescent children
There are several efforts and initiatives within local communities (e.g. in
Ljubljana) to work with parents of adolescents in different ways and through
different channels (e.g. organizing “School for parents” within school, centre for
social work or in a church; organizing meetings for parents to discuss different
topics with professionals). The contents vary a lot – from parental skills to
specific information about drugs.

b) Interventions in crèche/kindergarten and other specific interventions in
Health promotion of pre-school children is addressed by “The healthy
kindergarten” project in Slovenia. More than 40 out of approximately 300
kindergartens are members of the network. The intersectoral project (the
initiative came from the health sector that lives within education sector)
addresses education, teaching methods, communication, risk factors (e.g.
physical activity, safety, smoking, nutrition, hygiene). The magazine with
relevant articles (e.g. Let us listen to children, Children and communication,
Recycling, toys for small children, Healthy nutrition in kindergarten) and news
(e.g. Quit smoking and win, News from healthy kindergarten) is published. The
aim of the project is cooperation of kindergarten teachers, parents and local
community with the goal of achieving healthier lifestyle within kindergarten and
consequently better health.

c) Statistics and evaluation results
Not available.

d) Specific training
The service of social prevention shall be provided by social work centres, often
in cooperation with the providers of local youth programmes. The service is
predominantly intended for the stimulation of social inclusion and is not
exclusively focused on the prevention of drug abuse.




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9.1.2. School programmes

a)   Mandatory, recommended or voluntary solutions at different school
     levels

a1) Mandatory/recommended solutions for elementary schools
Over the last decade, the Slovene education system has experienced thorough
and all-encompassing modernisation. Principles forming the basis for the
renewal were set at the beginning and are as follows:
       - Accessibility and transparency of the public education system,
       - Legal neutrality,
       - Choice at levels,
       - Democracy, autonomy and equal opportunities,
       - Quality of learning.
The new legislation (1996 – 2000) includes acts on the organisation and funding
of education, pre-school education, elementary and grammar school education,
vocational and technical education, adult education, higher education,
professional and academic titles, school inspectorates, music schools,
placement of children with special needs, vocational certification.
Changes have been introduced gradually according to the legislation adopted,
in parallel with the gradual provision of facilities and staff. Most curricula were
renewed; mechanisms for monitoring the implementation were developed. The
new system will be fully adapted in 2003/2004.

Education for health as a cross-curricular field is a novelty within Slovene
educational system. The cross-curricular field is a thematic field that has its
specific topics and contents (like any other subject). They are carried out within
several subjects (foreign language, mathematics, geography etc). In Slovene
educational system are 3 CC fields: environmental education, professional
orientation and education for health.

The National Curricular Council nominated a special group of professionals who
prepared the program for the Education for health. The group tried to take into
account and build on achievements, experiences and recommendations for
education for health:
    of Slovene teachers;
    of teachers from foreign countries, e.g. Hungary, the Netherlands,
      Norway, United Kingdom, France;
    of international organisations (e.g. WHO);
    of international projects (e.g. European Network of Health Promoting
      Schools).

The group prepared recommendations for holistic approach to health within
school framework – whole school approach to health. Education for health does
not begin and end in the classroom. All aspects of school life have to respect
their influence and importance for health. It is about supportive school
environment (at micro and macro level), hidden curriculum, quality of
interpersonal relations, cooperation with local community, school nutrition etc.



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Everyday life should offer opportunities for strengthening the knowledge and
information passed to children in the context of education for health.
Recommendations on didactics and teaching methods were prepared. Special
attention was put on development of action competence. Recommendations in
connection with organisational questions were prepared. Two groups of
subjects were identified:
    - supporting subjects (science, sports, techniques, home economics);
    - supplementary subjects (history, geography, Slovene language,
       mathematics, music, art, foreign languages);
    - activities were identified (class meetings, recreation break, days of
       activities etc).

These are the nine major groups of contents:
   - family life,
   - psychological aspects of health,
   - personal hygiene,
   - education for healthy sexual life,
   - food and nutrition,
   - physical activity and health,
   - safety,
   - first aid,
   - use and abuse of substances.

For every content group the aims and topics were identified. E.g. for use and
abuse of substances:

Aims:
   - Schoolchildren should realise that all medicines are drugs but all drugs
      are not medicines.
   - There are substances that could be bought without a doctor‟s
      prescription and substances that could be bought only on the basis of a
      doctor‟s prescription; pupils have to understand their effects on human
      being.
   - To adopt general safekeeping measures for medicines and other
      substances (diluents, substances for cleaning…).
   - Schoolchildren should know the characteristics of the decision making
      process; they should adopt peer pressure resistance skills.
   - Schoolchildren should know that everybody is personally responsible
      while deciding whether to take drugs or not.
   - Schoolchildren should be informed about drugs and their effects.
   - Schoolchildren should be informed about drugs related legislation.
   - Myths and stereotypes about drugs and drug users should be discussed.
   - Schoolchildren should be informed about historical, cultural and social
      factors/conditions related to production, distribution and use of drugs all
      over the world.
   - Schoolchildren should realise that drug use is present also in Slovenia.




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   -   Schoolchildren should understand the formative role of mass media in
       values, attitudes towards drug taking, especially tobacco smoking and
       alcohol consumption.

Topics:

   -   What are medicines?
   -   What are drugs?
   -   Health related decision making process
   -   The process of becoming addicted – from nonuser to addiction
   -   Why do people abuse drugs?
   -   Alcohol
   -   Tobacco
   -   Cannabis
   -   Other illegal drugs
   -   Important steps in decision making process
   -   Peer pressure
   -   How do you say “no”?
   -   First aid
   -   Self-concept

Suggested literature for teachers and pupils was cited.

The proposal for the curriculum was published in a booklet. The next step for
successful completion of the curriculum is preparation of detailed interrelations
of education for health contents with curricula of other subjects.

The Slovene Network of Health Promoting Schools (SNHPS)
The Republic of Slovenia is a member of the ENHPS (European Network of
Health Promoting Schools) since March 1993. Three phases were undergone
within the past time:
    - Pilot phase (1993 – 1996; 12 schools; 1 secondary, 11 elementary)
    - Dissemination phase (from January 1997 on; 130 schools; 100
        elementary)
    - Phase of national strategy building (from March 2000 on, not very
        efficiently)
The Slovene project developed the whole school approach to health; it strives to
follow 12 internationally set goals. The recommendations from Ottawa charter
for health promotion were borne in mind while structuring the programme.
There are three characteristics of Slovene programme:
    - Education for health curriculum
    - Hidden curriculum
    - Co-operation with local community
The project is planned and evaluated on a six months basis. Every member
school (school project team) plans activities according to their own problems,
needs, interests and consideration. Teachers and other staff are trained in order
to be competent to carry on the programme. The in-service training is organised
by the National Institute of Public Health (the national support centre for the



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project) or by other institutions. NIPH analyses activities within network on a
yearly basis.


Figure 9.1.1.       The activities of SNHPS by content in the s. y. 2000/01
                    (all schools)



                                     Other       Oral health   Nutrition
                                     14%             4%           8%

                                                                       Ecology
            Social activities                                            2%
                  4%
                                                                              Sexual education
                                                                                    4%


            Active learning                                             Mental health
                  14%                                                         15%

                Changes in
               environment                                          P hyisical activity
                    5%                                                     9%

                     Health educatin -                         Leisure time
                          general                                  4%
                                             Addiction
                                5%
                                               12%




Source: Eva Stergar, Institute for Public Health



In 2000/2001 the most frequent contents were mental health promotion (15% of
all activities; 15% in primary schools, 16% in secondary schools) and drug use
prevention (12% of all activities; 19% in secondary schools, 11% in elementary
schools). It should be mentioned that during the whole year 2000/2001 a project
called “Message in the bottle” was going on as a part of the European initiative
at the occasion of Stockholm‟s ministerial conference Young people and
alcohol.


a2) Voluntary solutions at school level

According to recent analysis performed by the National Council for Healthy
Lifestyle of Schoolchildren many schools carry out various programmes aimed
at the drug use prevention. The initiative for programs derives from at least four
sources:
    - The school feels the need to carry out the programme and seeks for
        appropriate programme/performer.
    - The programme is “offered” by GOs or NGOs.



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     -    The local community offers support for drug use prevention programmes.
     -    The ministries (of health, of labour, family and social welfare) invite in the
          framework of public official invitation for tenders to prepare drug use
          prevention/social skills/spare time activities programmes.

The programmes vary according to duration, performers, topics and methods
used. There are no verification mechanisms, with the exception of those
programmes that are financed through public official invitations.


b)       General (health promotion, life skills) or specific (directed to high risk
         groups) programmes

b1) General programmes

The Mental health promotion programme was developed within ENHPS.
Slovene schools have participated in it from the pilot phase on. The programme
consists of in-service training of teachers and the manual written by Gay Gray
and Katherine Weare (University of Southampton). The manual was translated
to Slovene language and adapted to our conditions. The long-term goal of
SNHPS is that all participating schools organise in-service training on mental
health promotion for all their teachers and staff. From 1993 till the end of 2001
75 seminars were organised – more than half of member schools and their staff
attended the seminar. The programme covers the following topics:
    - What is mental health?
    - Building self esteem
    - How to assess the situation in our school?
    - Effective listening and responding effectively
    - Managing stress in school
    - Managing change in school
    - Energisers (ice breakers)
    - Group forming

Three more general programmes were developed within SNHPS:
    - Managing stress in primary school
    - Managing stress in adolescence
    - Communication and personal relations among students, teachers
        and parents (basic, advanced)
All the mentioned programmes are incorporated in the system of permanent
training of teachers. They are most effective when implemented with majority of
staff of one school. Till 2001 36 seminars on communication were performed,
six on stress management in primary school and two on stress management in
adolescence.

Besides mentioned seminars there is a wide range of in-service training offered
to Slovene teachers within the system of lifelong education every year. Many of
them cover mental health, psychological, educational, communication… topics.




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Every year schoolchildren have the opportunity to participate in children’s
parliament. The initiative comes from NGO, the programme is implemented
within schools that decided to participate. Every year pupils choose the theme
for discussion (in 2001 it was spare time, in 2000 personal relations). They
discuss it at several levels (school, community, region). The programme
culminates with a delegates‟ discussion in Slovene parliament: delegates
expose their views, they suggest solutions and the theme for the next year is
chosen. In the preparatory phase teachers follow the seminar. They get written
material and guidelines.

b2) Specific programmes

Institute of Public Health of the Republic of Slovenia co-developed three specific
programmes:
a) Non-smoking promotion
b) Alcohol? Adults may have influence
c) Quitting smoking

Non-smoking promotion in schools
The initiative for development of the programme derived from the members of
the Slovenian Pulmonary Patients Association. Their members prepared the
programme (manual for the teachers and work sheets for pupils) in cooperation
with NIPH‟s professionals. The production was done by NIPH. The programme
has been introduced gradually within SNHPS (it started with 11 schools in
2000/2001; in 2001/2002 44 more schools entered the program). The
programme starts with one-day seminar for teachers from relevant class. The
programme is delivered cross-curricularly from 3rd to 8th class of primary school.
The programme is evaluated on a pre-test post-test basis. Feedback from
teachers implementing the programme is analysed.

Alcohol? Adults may have influence
The programme was developed in 2001 within Ljubljana – Healthy city project.
The long-term goal is to reduce harmful alcohol consumption among young
citizens of Ljubljana. The short-term goals were: to inform parents about alcohol
and its effects on human beings and their health in the broadest sense; to
inform parents on parental skills; to educate teachers for implementation of the
programme. The program consists of training for teachers, manual for teachers,
booklet and leaflet for parents, booklet for pupils, Bulletin for all three groups (it
was published within the SNHPS at the occasion of the project Message in the
bottle). All the materials and books were prepared – this is true for all the
programmes prepared within NIPH – on the basis of pre-testing the relevant
groups (relevant surveys were done).
Teachers who were trained at NIPH deliver the programme.
The programme was offered to the Ministry of Health for further dissemination in
Slovenia. In 2001 two regions disseminated the program.




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Quitting smoking
There are several programmes to support quitting smoking in Slovenia: Quit &
Win competition that takes place every year; a programme supported by the
Pharmacists‟ chamber; the programme to support GPs work with clients who
quit smoking (developed by the NIPH); CINDI quit smoking programme; there
are several private initiatives.

c)   Involvement of: Teacher, parent, community

As it is probably seen from the previous text all three groups are involved in
prevention efforts in Slovenia. Since there was said enough about teachers and
parents involvement, a few words should be written about the work of Local
Action Groups (LAG) in Slovenia. LAGs have been developed following
recommendations of WHO since 1992. LAG consists of professionals,
individuals and groups who have common interest. The long-term goals of LAG
are: analysing the problem, programme planning, reduction of harm caused by
drug use, preventive efforts in local community, healthy lifestyle promotion. The
group assures co-ordinated action, holistic approach to the problem in the
community. LAG raises awareness and initiates local action. Since 1996
Slovene LAGs organise meetings on a yearly basis.
It is estimated the role and influence of LAGs are very important for holistic
approach to drug use problem.

d)   Guidelines for school policy

Not yet prepared.

e)   Specific research results, statistics and evaluation results

Workshops on mental health promotion
The evaluation showed increased awareness of pupils: after the programme
they were able to identify a significantly greater number of elements constituting
mental and emotional health and were more aware of their impact on their own
mental health. The programme had some impact on pupils‟ attitudes towards
mental health. The learned mental health skills were inadequate to be used
effectively in everyday life situations. Both, the students and teachers, were
very satisfied with the programme.

Non-smoking promotion programme
The programme is evaluated on a pre-test post-test basis. The analysis of the
first year of implementation shows there was statistically significant change in
attitudes of pupils of 3rd grade.




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9.1.3. Youth programmes outside schools

a)   Types, settings of activities

There are programmes run by GO (usually based in the Centre for social work)
and NGOs (Information centres for young people, Pupils‟/students‟
associations, Interest groups…). Their activities vary a lot – from general to very
specific topics. The information centres for young people have their national
coordinator. Their role is to inform and advise young people, to plan and
implement various programmes. They organise workshops for pupils, support
Internet page etc.

b)   Peer-to-peer approaches

There are many initiatives for peer education in the field of drug use prevention.
Probably the most active is the association of students of medicine (Slomsic)
who have regular workshops in secondary schools (sex, drugs, aids
prevention).
A special programme that involves dropouts from schooling should be
mentioned. It is called production school and offers opportunity to dropouts to
develop functional knowledge and consequently play more active role.

c)   Target groups

Prevention programmes address different target groups. The most frequent are:
pupils, teachers and parents.

d)   Specific research results, statistics and evaluation results

Not available.

e)   Specific training

The programmes are usually introduced by training of those who implement the
programme.




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9.1.4. Community programmes

The network of services of public service and the network of programmes for
solving social problems related to drug use shall be ensured by the following:
   1. Services and programmes for the sensitisation of the highest possible
       number of drug users (first social assistance, programmes of fieldwork
       and other low-threshold programmes),
   2. Services and programmes of short-term interventions (personal
       assistance, assistance to a family at home, low-threshold programmes
       and programmes of mutual assistance),
   3. Programmes focused on the achievement of permanent abstinence
       (therapeutic communities, programmes of whole-day treatments),
   4. Services and programmes of reintegration (service of personal
       assistance and assistance to a family at home, reintegration
       programmes),
   5. Forms of self-help and self-organization of drug users or people who are
       close to them.

The goal of the network of services and programmes is to assure an active
participation when solving person's own problems and to assure the possibility
of selection between the various ways of solving these problems. Therefore it is
necessary to enable the work of various providers of programmes and related
development of new approaches for management of social issues. This is also
a part of the strategy when implementing a social-care rights. This strategy has
been defined by the Ministry of Labour, Family and Social Affairs in its National
Social Care Programme until 2005.

Individual programmes also include forwarding of information and a provision of
telephone assistance. There are no providers which offer exclusively this form
of assistance to drug users and persons who are close to them.


9.1.5. Telephone help lines

a)    Interventions at national/regional/local: their characteristics (type of
      information, costs)
There are many help lines that cover various parts of Slovenia; some are
nationwide, others are local. Their numbers are advertised in newspapers for
free. Some are general (e.g. telephone for children and youth), others offer
specific help (e.g. quit smoking line, AAA, aids, battered women line).
Some are free of charge – The Sound of Reflection Foundation help line.


b)   Statistics and evaluation results




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Help lines analyse their work on a yearly basis (usually the report is needed for
those who finance the line/programme). Some of them present the results in
public.

c)   Specific training

Usually help lines train their staff – according to the topic they are dealing with.


9.1.6. Mass media campaigns

a)   Types and characteristics of mass media campaigns (TV, radio,
     posters…)

There was campaign to promote quitting smoking in December 2001 (TV spot,
PR activities) at national level.
Another tobacco related campaign was going on in June at the occasion of
World No-tobacco Day (billboards, posters, leaflets, public event).
A lot of PR activities were done in relation to illegal drug use (the news were
published mainly in the press and on TV).

b)   Cooperation with mass media (costs and sharing of the costs with
     media)

The Slovene mass media are helpful in passing information to their public. The
national TV broadcasts advertisements for free, the commercial networks give
substantial discounts.
The press conferences are usually well covered by all types of media.

c)   Statistics and evaluation results

Clipping is gathered but not analysed.

d)   Specific training

There is no specific training for mass media campaigns in the field of drug use
prevention.




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9.1.7. Internet

a)   Use of Internet for:
         - prevention
         - dissemination of prevention know-how among professional


Surfing the Internet shows quite a huge number of Slovene pages dealing with
drugs. The interests, goals and consequently contents vary a lot: from
prevention (e.g. DrogArt: Prevention of harm caused by party drugs, The Sound
of Reflection Foundation – counselling on drug related problems) to information
of marijuana growing. Many pages offer conferences, counselling, possibilities
for visitors to ask questions and get answers.
According to the research on the use of Internet in Slovenia 21% of Slovene
households and nearly all the schools have access to the Internet. On the other
hand the Internet and sitting behind one‟s PC is not the way of prevention we
would highly recommend (radiation, sedentary lifestyle, lack of
communication…).
Here are some addresses of home pages dealing with drugs:
www.web.infopeka.mlz.org
www2.arnes.si/ljmisss1
www.drogart.org
www.uradzamladino.org
www.uradzadroge.gov.si
www.ustanova-odsevseslisi.si


b)   Statistics and evaluation results

Not available.




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9.2. Reduction of drug related harm

Description of news developments in strategies aiming at prevention of drug
related harm


9.2.1 Outreach work

a)   Strategies (youth work approach, family/community approach, “catching
     clients”, public health model, self help initiatives, etc.)

 Target group is not defined by age but with “risk behaviour population”
  related to drug use.
 One of preferable methods is to involve drug users as volunteers to work
  with the outreach team as s contact people for other IDU population. Later,
  when we have already established contacts in some areas, our outreach
  team works independently.
 Outreach work include distribution of sterile equipment for safer drug use,
  information about safer use, safe sex, information about different services
  and motivation approach for IDUs for regular use of stationary needle
  exchange.
 As self-help component of outreach work we have included some drug users
  as volunteers who work as distributors of sterile equipment (users for users)
  in some private locations where many drug users gather together.

b)   Target groups

Our target group related to outreach work are injection drug users (IDUs), who
are mostly hidden from established services.

c)   Synthetic description of actors and instrument

Personnel from Aids foundation Robert
    medical doctor, specialised in social medicine (top director)
    professor of health education – counsellor related to STDs
    6 social workers (two on outreach, three in drop-in centre, one on the
      counselling help-line)
    social pedagogue (a project leader of Stigma project)
    two men with secondary school (one on needle exchange, one on the
      counselling service)
    subprojects: needle exchange, distribution of condoms, outreach work,
      drop-in centre, counselling service related to drugs and STDs (by phone,
      e-mail or personal by appointment).




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d)    Statistics and evaluation results

Statistic of outreach work in 2001:

Table 9.2.1.     Issued and returned syringes

Issued syringes with needles                       51.410

Returned syringes with needles                     39.333


Source: Dare Kocmur, Aids Foundation Robert



e)    Specific training

Specific training for outreach workers is connected mostly with outreach work
methods. Basically, outreach team has been educated as social workers. Other
education contained basic principles of harm reduction, health issues, safer
drug use, safe sex and ethnographic approach. The members of our
organization participated in many different workshops and conferences on
international and national (local) level, they were also included in the internal
education and participated on some specialization seminars organized by the
High School for Social Work.


9.2.2. Low threshold services

a)    Organisational framework: structures (public service, NGO, cooperation
      schemes), tasks and special services

Related to the public service we have 15 centres for methadone maintenance
treatment. Related to NGOs we have three low-treshold centres dedicated to
IDUs. One is an organization Aids foundation Robert / Project Stigma that
contains: drop-in center, needle exchange, outreach work, counseling service.
Two others known low-treshold services are on probation and unstable, with a
small amount of clients and financial support. They are from cities of Koper and
Maribor.
The organisation “Drogart” works on harm reduction related to dance drugs,
mostly with spreading harm reduction messages from their web site and
distributing the information leaflets at rave parties with its voluntary group .
Officaly there is a network of methadone centers and on the other side a
network of NGOs (but in the last case this does not mean only low-treshold
organizations). Basic criteria for involvement is NGO status in drug field.




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b)   Target groups

Except “Drogart” which have a target group related to a dance drugs population
the other organizations mentioned above are connected mostly with heroin and
the other hard drugs users.


c)   Statistics and evaluation results

We only can offer statistic about needle exchange and outreach programme –
from project Stigma:

Statistic of needle exchange in 2001:

Visits in 2001:                       7718
Issued syringes with needles:      144.693
Returned syringes with needles:     98.815


d)   Specific training

Education contained basic principles of harm reduction, health issues, safer
drug use and safe sex and ethnographic approach. The members of our
organization have participated in many different workshops and conferences on
international and national (local) level, have been also included in the internal
education and participated at some specialization seminars organised by the
High School for Social Work.




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9.2.3. Prevention of infectious diseases

a)     Synthetic outline on organisation, strategies and actors

    Aids Foundation Robert

Methods used:
needle exchange, outreach work, counseling service related to drugs, safe sex,
and STDs

    Centers for the Prevention and Treatment of Drug Addiction

Methods used:
 vaccination against hepatitis B
 counseling service related to drugs, safe sex and STDs
 education
 informational materials, leaflets: Vaccination against hepatitis B,

    Center for Treatment of Drug Addicts

Methods used:
 vaccination against hepatitis B
 counseling service related to drugs, safe sex and STDs
 education
 informational material

The Sound of Reflection Foundation:
 education
 informational material
 training on Overdose



b)     Principal interventions:

    needle and syringe exchange
    safer sex/safer education (in the frame of counselling service)
    testing, vaccination
    organisation of seminars, workshops, education
    preparing informational material – leaflets, manuals

c)     Providing equipment

Sterile insuline syringes with integrate needles, 2 or 5 ml syringes with separate
needles, alco swabs, ascorbine acid, esmarch, condoms, information material

d)     Statistics and evaluation results



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-



e)   Specific training

Education has contained basic principles of harm reduction, health issues, safer
drug use and safe sex and ethnographic approach. The members of our
organization have participated in many different workshops and conferences on
international and national (local) level, have been also included in the internal
education and participated at some specialization seminars organised by the
High School for Social Work.




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9.3. Treatments

9.3.1. Treatments and Health care at national level

is performing according to the Health Care and Health Insurance Act (Official
gazette 9/92), Prevention of the Use of Illicit Drugs and Dealing with Consumers
of Illicit Drugs Act (Official gazette 98/99),
In article 8 is defined that the treatment of consumers of illicit drugs shall be
carried out in the form of hospital and outpatient clinic treatment programmes
approved by the Health Council at the Ministry of Health of the Republic of
Slovenia.

The treatment referred to in the preceding paragraph shall be carried out by
natural and legal persons who fulfil the conditions defined for the performance
of medical activities in accordance with the act governing medical activity.
In accordance with this Act, “treatment shall also be deemed to be maintenance
with methadone and with other substitutes approved by the Health Council.”

Article 9 defined that for the implementation of hospital and specialist outpatient
clinic treatment, the Government of the Republic of Slovenia shall establish a
public health institution – the Centre for Treatment of Illicit Drugs Addicts.
Hospital treatment shall be deemed to be hospital detoxification, psychosocio-
therapeutic treatment, extended treatment and health rehabilitation.


a)    Services offered and their characteristics

1.    Outpatient treatment

    Centres for the Prevention and Treatment of Drug Addiction, located at
     the primary care health system

Some of the main already reached goals concerning the HIV/aids epidemics in
establishing the network of Centres for the Prevention and Treatment of Drug
Addiction have been:

-      To provide medical care to all persons with health insurance in the
       Republic of Slovenia.
-      To further develop and strenghten the methadone maintenance program
       and other substitution programs.
-      To develop a manual for methadone maintenance program.
-      To develop community and outreach harm reduction programs.
-      To assess the extent of HIV-risk behavior and HIV infection among
       injecting drug users.




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2.    Inpatient treatment and care

    Centre for Treatment of Drug Addicts, Clinical Department of Mental
     Health, Psychiatric Clinic in Ljubljana

Centre for treatment of drug addicts at the Clinical Department for Menthal
Health of Psychiatric Clinic in Ljubljana with nine beds is the only specialised
hospital unit offering inpatient treatment.

    Psychiatric Clinics in the Republic of Slovenia

All Psychiatric Clinics in the Republic of Slovenia offer drug-free treatment.


b)    Objectives

    Centers for the Prevention and Treatment of Drug Addiction offer drug-
     free treatment and not drug free treatments.

    Centre for Treatment of Drug Addicts, Clinical Department of Mental Health,
     Psychiatric Clinic in Ljubljana offer drug-free treatment and counselling for
     users, relatives and proffessionals.

    Psychiatric Clinics offer drug-free treatment


c)    Criteria of admission
-      Voluntary
-      Compulsory treatment order
-      Referral from the Centres for the prevention and treatment of drug
       addiction


d)    Involvement of public health services and GPs

General health care

Since 1995 GPs were included in training programmes organised by
Coordination of Centres for the Prevention and Treatment of Drug Addicts of the
Ministry of Health. They are cooperating with CPTDAs concerning their clients
and information exchange. Every client at CPTDA has to registre with chosen
GP, who takes care of clients health problems other than addiction in
cooperation with the doctor at CPTDA.

In the future GPs, pediatricians, school medicine specialists and family doctors
should take more important role in the treatment of drug use and addiction,
especially with young users. To do so they would need more training and
support from specialised units.



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e)   Coordination between public health services and other community
     drug services

The minister responsible for health shall appoint the body for the coordination of
the centres for the prevention and treatment of addiction to illicit drugs, which
shall propose a treatment doctrine, verify the implementation of the addiction
treatment doctrine and coordinate professional cooperation between the centres
for the prevention and treatment of addiction to illicit drugs.

Coordination of centres for the prevention and treatment of addiction on
regularly monthly meetings invite all responsible persons in the field of drugs:
health, social, justice sectors, NGOs etc.

Activitities:

1.    Regular monthly sessions:
 the first part, intended for the members of Coordination centres (people
    managing the centres, representatives of the Ministry of Health and the
    Centre for Treatment of Drug Addiction)
 the second part usually consists of professional lectures, panel discussions
    on selected topics etc.
Everyone involved in the concerns and issues of illicit drug abuse in the country
is welcome to attend.

2.   Organisation of conferences, seminars and workshops
In addition to elementary seminars, the Coordination of Centres for the
Prevention and Treatment of Drug Addiction organised the following
awareness-raising events:

In 1997 (September 17 - 20) a conference was organised in Ljubljana, at
Cankarjev dom Congress Centre, in cooperation with EUROPAD (European
Opiate Addiction Treatment Association - "Heroin Addiction in Europe": 3rd
European Methadone and Other Substitution Treatments Conference together
with Regional Meeting of Central and Eastern European Countries on
Treatment Programmes with emphasis on Outreach and Open Community
Approach.

867 participants from most of the European countries, as well as from the
U.S.A., Asia and Australia, attended.

In 1999 (May 20 - 25), the 1st Slovenian Conference on Addiction with
international participation was organised in Ljubljana by the Coordination
body and by the Sounds of Reflection Foundation.

Participation in the organisation of:
1st Slovenian Conference on Addiction Medicine, Ljubljana, 1996



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2nd Slovenian Conference on Addiction Medicine, Bled, 1998

3.    The most important changes in the doctrine that have emerged
      through the network:

     Enlargement of the network with new centres and expansion of the
      existing centres and outpatient clinics in the network
In 1995, nine centres for the prevention and treatment of addictions from the
illicit drugs were opened, bringing the total number of centres to fifteen
 Development of prevention programmes
 Developing the doctrine of a treatment of addiction, especially with
      regard to the drug users' working and driving ability
 Fast urine tests for establishing the presence of illicit substances (a
      guide booklet has been published)
 Testing for hepatitis B, C, and HIV
 Immunisation against hepatitis B infection
 Implementation of treatment for hepatitis C
 Treatment of drug dependent pregnant women; cooperation with
      gynecologists, obstetricians, pediatricians
 Cooperation in developing the doctrine of treating drug addiction in
      penal institutions
 Cooperation in developing the doctrine of medical examination of
      draftees in the Slovenian military service
 Implementation of the Pompidou Group questionnaire "First Treatment
      Demand"

4.    Coordination of centres has been also preparing publishing material:

    Professional poster "Network of Centres" in Slovenian and English
    Registration card for participants in the methadone maintenance programme
    Folded information leaflets :
      Hepatitis C
      Instructions for immunisation against hepatitis B
    Manuals:
      What Should You Know About Methadone
      Women and Drugs
      Urine Tests
      Overdose
    Club drugs
    Marihuana

5.    Revised Guidelines for Medical Professionals

6.     Over thirty research studies were completed in the centres.




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7.     Members of the Coordination body have published their articles in
       Slovenian and international publications: Euromethwork, European
       Addiction Research, Journal of Heroin Addiction

8.     Some members of the Coordination body serve on editorial boards of
       foreign professional journals: Addiction Research, Journal of Heroin
       Addiction.

9.     Coordination body has organised conferences in conjunction with
       foreign organisations:
      - EUROPAD (European Opiate Addiction Treatment Association)
      - IHRA (International Harm Reduction Association)

10. Members of the Coordination body share their insights and
    knowledge with colleagues at conferences and seminars at home
    and abroad.

11. Some members of the Coordination body have actively participated
    in the development of the doctrine "Women, Children and Drugs"
    together with the organisation Child and Parenthood and the Pompidou
    Group.

12. Members of the Coordination body have actively participated in
    drafting the European guidelines for the methadone maintenance
    programmes.

13. The Coordination body through the media regularly informs the
    public on all aspects of its work.

14.     Publishing magazine: Addiction

15. Members of the Coordination body have established a foundation
    Odsev se sliši - The Sound of Reflection Foundation.


f)     Special services
-

g)     Financing

Program of treatment of drug addiction is covered by Health Insurance
Company of the Republic of Slovenia.




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h)     Statistics and evaluation results


    Number of treated patients in Centres for the Prevention and Treatment
     of Drug Addiction

Table 9.3.1.             Number of patients In Centres for the Prevention and Treatment
                         of Drug Addiction from April 1995 to March 2001

                                          Methadone maintenance
    Year                                                                                  All patients
                                               programme
    1995                                           530
    1996                                              729
    1997                                              926                                    1414
    1998                                              1034                                   2599
    1999                                              1198                                   3000
    2000                                              1348                                   2540
    March 31, 2001                                    1347                                   2264

Source: Ministry of Health, 2001



Figure 9.3.1.             Number of patients in Centres for the Prevention and Treatment
                          of Drug Addiction from April 1995 to March 2001



           3000

           2500

           2000

           1500
                                                                                               MMP
           1000
                                                                                               All patients
            500

                  0
                  1995                                                     All patients
                          1996   1997
                                        1998                              MMP
                                               1999
                                                            2000
                                                                   2001



Source: Ministry of Health, 2001




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Table 9.3.2.     Number of patients in the Centre for Treatment of Drug Addicts
                 at Psychiatric Clinic Ljubljana - hospital unit

Year                         Women                   Men                  All
1995                           28                     52                  80
1996                           21                     56                  77
1997                           29                     54                  83
1998                           25                     68                  93
1999                           33                     68                 101
2000                           38                     71                 109
2001                           35                     79                 114
Total                         209                    448                 657

Source: Centre for Treatment of Drug Addicts at Psychiatric Clinic Ljubljana



Table 9.3.3.     Number of patients in the Centre for Treatment of Drug Addicts
                 at Psychiatric Clinic Ljubljana - outpatient unit

Year                                 No. of clients in outpatient treatment
1995-2001                            3250 patients

Source: Centre for Treatment of Drug Addicts at Psychiatric Clinic Ljubljana



i)      Specific training

There were organized a lot of elementary and specific trainings for doctors,
nurses, social workers, pharmacists, psychologists by the Coordination of
Centres for the Prevention and Treatment of Drug Addiction at the Ministry of
Health from 1995 to 2000.


j)      Other national specifications
-




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9.3.2. Substitution and maintenance programmes


The methadone maintenance program is one of the fundamental harm
reduction approaches accepted within current drug policy that aims to protect
the users of illegal drugs by increasing the number of users who make contact
with the medical service, to diminish the prevalence of HIV and hepatitis B,C
among them and to diminish the criminality.

National guidelines for the management of drug addicts including methadone
maintenance programme have been adopted by the Health Council at the
Ministry of Health of the Republic of Slovenia in 1994. The ministry adopted a
set of recommendations for doctors concerning the treatment of drug addicts.

Methadone maintenance programme policies were confirmed at a consensus
Symposium on Methadone Maintenance with participants from the Ministry of
Health, the Ministry of Internal Affairs, the Ministry of Labour, Family and Social
Affairs, and the Ministry of Justice in 1994. Further reviewing of guidelines was
done in 2000.

a)   Organisation and delivery of substitution drugs

A network of Centres has been confirmed in the Republic of Slovenia in 1995.

Services provided by CPTDAs

The drug prevention and rehabilitation centres provide:
-     counselling service for addicts, relatives and educators
-     individual, group and family therapy
-     preparation for hospital treatment
-     aid towards rehabilitation and social reintegration
-     consultations for health and social services
-     determination on the basis of case history, clinical examination,
      laboratory tests and welfare service reports of indications for the
      application of the methadone maintenance programme
-     supervision of the methadone maintenance programme
-     practical implementation of methadone maintenance programme
-     community health nursing service
-     linkage with therapeutic and self-aid groups
-     research work
-     epidemiology




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Staff Requirements of CPTDAs
In view of the complex nature of drug dependence treatment, the normal
operation of a drug prevention and rehabilitation centre requires a
multidisciplinary team of specialists including:
-      a general medicine or social medicine specialist
-      a college-graduate nurse
-      a consulting or permanently employed psychiatrist
-      a psychologist
-      a social worker
-      a laboratory technician
-      an administrative worker


Methadone Maintenance Programme

After establishing that the criteria for inclusion on the programme have been
fulfilled, that all the aforesaid examinations and laboratory tests have been
made and contact with the welfare service established, the team meets for joint
consultations about the indications for placing the addict on the methadone
programme.
The final decision on the placing of the drug user on the methadone programme
is made by the programme manager after consultations with the team.


The patient must meet and talk with his counsellor (chief consultant) at least
once a week and/or receive one of the forms of psychotherapy once a week.

Methadone dispensing units are outpatient clinics or pharmacies. They do not
need to be situated within the Centres for Drug Prevention and the Treatment of
Drug Addicts.

Methadone may only prescribe a doctor chosen by the adict, who has received
the corresponding licence from a CPTDA and who has gained the basic
knowledge at a training course organised by the Ministry of Health and the
Clinical Department for Mental Health.

It is recommended that the other doctors prescribe methadone to the addict
only in the absence of his/her doctor and in agreement with him/her.

Doctor may authorise a doctor at CPTDA or his colleague in the community
health centre to prescribe and dispense methadone to the patient and to apply
other necessary therapeutic measures if such arrangement is more expedient
for the patient in the programme or for the organisation of the work.

Methadone is administered in the form of a solution mixed with fruit juice and is
taken daily in the presence of a nurse, preferably a graduate of nursing college.
Patients may take methadone at home only over weekends and during national
holidays or on the basis of special therapeutic agreement.



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If not abusing heroin, she or he can take methadone home for two days, after
three months she/he can take it home for three days and after half a year for a
week. Some doctors argue that tablets should be prescribed for a stabilised
patients.


b)   Criteria of admission

Minimum requirements for placing an addict on the methadone maintenance
programme (MMP) are:

 opiate addiction in the duration of at least one year and current physical
  dependence;
 previous detoxification attempts;
 written consent for the inclusion on the MMP;
 minimum age of 18;
 permanent residence in the region where a drug prevention and
  rehabilitation center is located;
 the addict's own choice of the doctor;
 health insurance.


c)   Mode of prescription

Methadone is administered in the form of a solution mixed with fruit juice
(Heptanon 100 mg/10 ml and 1000 mg/100 ml).


d)   Objective (gradual detoxification, maintenance)

Treatment is performing according to the EU Methadone Guidelines:
 Short term detoxification: decreasing doses over one month or less;
 Long-term detoxification: decreasing doses over more than one month
 Short-term maintenance: stable prescribing over six month or less
 Long-term maintanence: stable prescribing over more than six month


e)   Substitution drugs, mode of application

 Methadone
 Buprenorphin and long acting morphine is being introduced




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f)    Psycho-social counselling (requirements and practice)

Possibilities of participating in psychosocial treatment

All patients have the possibility to participate in the psychosocial treatment.
Only 6.5% have not been offered the psychosocial treatment.

Figure 9.3.2.          The possibilities of participating in psychosocial treatment


                                               3.2%
                                    other
                                                  6.5%
                              not offered
                                                         16.1%
                           family therapy
                                                                  22.5%
                           group therapy                                                                            2,000
                                                                      27.2%                                         1,997
             counseling of social workers
                                                                                                                    1,995
                                                                          28.5%
               counseling of psychologist
                                                                                  34.0%
               counseling of psychiatrists
                                                                                                           60.2%
                counseling of physicians

                                        0.0%    10.0%    20.0%      30.0%          40.0%   50.0%   60.0%           70.0%




Source: Kostnapfel Rihtar T., Kastelic A.: Evaluation of methadone maintenance programme in
the Centres for the Prevention and Treatment of Drug Addiction in 1995, 1997, 2000. In press.




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g)    Drug testing

Urine test

Figure 9.3.3.     Testing of urine on drugs

                                                    87,2%
                                                                         82,1%
       90,00%
                              59,6%
       80,00%
       70,00%
       60,00%         40,4%
       50,00%                                                                        no
       40,00%                                                                        yes
       30,00%                                               14,9%
                                       12,8%
       20,00%
       10,00%
        0,00%
                       1995               1997                 2000


Source: Kostnapfel Rihtar T., Kastelic A.: Evaluation of methadone maintenance programme in
the Centres for the Prevention and Treatment of Drug Addiction in 1995, 1997, 2000. In press.


h)    Diversion of substitution drugs

Selling methadone

According to a research 88,14% of clients included in the methadone
maintenance programme never selling methadone in 2000 and 10,7%
occasionally.




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Figure 9.3.4.         Selling methadone


                                                                                 88.14%

            never                                                                87.20%


                               10.71%
                                                                                          2000
      occasionally             12.10%
                                                                                          1997
                                                                                          1995
                       1.15%
         regularly
                       0.80%

                 0%    10%     20%      30%   40%    50%     60%   70%   80%   90%



Source: Kostnapfel Rihtar T., Kastelic A.: Evaluation of methadone maintenance programme in
the Centres for the Prevention and Treatment of Drug Addiction in 1995, 1997, 2000. In press.



i)    Statistics (measure point)

-


j)    Specific research results

A lot of researches were made in the Centres for the Prevention and Treatment
of Drug Addiction.


k)    Evaluation results

    Relevance

Attracting the majority of drug users to contact treatment programs as early as
possible is an important goal.
However, the prevalence of HIV infection is among injection drug users,
although low at present, possibly because of an early introduction of methadone
maintenance. Thus, HIV harm reduction interventions related to unsafe injecting
drug use and unsafe sexual behavior among injecting drug users are
considered a high priority.
The comprehensive programs of the network of 15 Centres for the Prevention
and Treatment of Drug Addiction and the National Centre for Treatment of Drug
Addicts have attracted a large number of drug users to participate in treatment.




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   Effectiveness and Efficiency

The inclusion of drug users in the user friendly forms of organized assistance,
as that provided by the network of centers, reduces the actual use of illicit drugs
and consequently the risks associated with drug use (especially with injecting)
such as HIV, hepatitis and other diseases.

A continuous implementation of prevention oriented programs and publication of
suitable information reduces the possibility of risk behavior.

The centres‟ methadone maintenance programs were evaluated in 1995, 1997
and the year 2000. The evaluation data are available and have been partly
published in the EUROPAD publication Heroin Addiction and Related Clinical
Problems. The results show that the methadone maintenance program was
considered “useful” to “very useful” for more than 90% of the patients.

Figure 9.3.5.             Usefulness of methadone maintenance programme


                              1.27%
            not useful
                                         10.08%
       partially useful
                                                                                      49.04%   2000
                                                                                               1997
                useful                                                                         1995
                                                                             39.59%
          very useful

                    0.00%       10.00%       20.00%        30.00%   40.00%       50.00%




Source: Kostnapfel Rihtar T., Kastelic A.: Evaluation of methadone maintenance programme in
the Centres for the Prevention and Treatment of Drug Addiction in 1995, 1997, 2000. In press.



The network of Centres for the Prevention and Treatment of Addiction provides
health care and various forms of assistance needed because of addiction.
These services are available to all health insured persons in the Republic of
Slovenia. The provision of health insurance is a mere formality and can be
obtained in a few hours at no cost to all citizens.
The network's cooperation with all addiction programs currently implemented in
the Republic of Slovenia, governmental and non-governmental, as well as low
threshold and high threshold, is an essential element in providing drug users
with integrated assistance.




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   Ethical soundness

Accessibility and respect for individuality are basic principles of all the programs
offered at the centers. All patients included in the programs are fully informed
about the operation and requirements of the program as well as their options
and sign an informed consent form.

Special programs for adolescents and drug dependent women are provided.
The treatment of addiction is the centers' top priority, and there are practically
no waiting lists.
Clients are encouraged to participate in the centers' program planning and
supervision Consumers' boards are being introduced.
There is a possibility for free legal aid.
The possibility for filing complaints regarding the centers has been incorporated
into the system.


   Sustainability

Programs for the treatment of addiction are defined by the law regarding the
prevention of illicit drug use and the management of drug users. This law
defines the forms of treatment and the establishment of centers for the
prevention and treatment of drug addiction. The centers‟ programs are
supported by the Slovenian Ministry of Health and funded by the Health
Insurance Institute.
The financing is provided in lump sums and does not entirely cover the cost of
full implementation of the programs, primarily because the number of users
seeking assistance is increasing.
To a smaller extent, the programs are partly funded by public tenders for
prevention projects.
Possibilities to become actively involved in the international projects are being
found.

The Sound of Reflection Foundation has been established by the staff in
charge of the centers with the hope of improving the funding of the programs.




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Figure 9.3.6.            Expectations of clients from the methadone maintanence
                         program



                                                 10.77%
                           Other
                                                                       34.79%
     Reducing criminal activities                                                                 59.64%

               Stop using drugs

                                                                     30.77%
                    Counselling
                                                                                                                      2000
                                                            24.38%                                                    1997
          Health care treatment
                                                                                                                      1995
                                                                       37.75%
                 Start treatment
                                                                                                    64.02%
                  Feeling better
                                                                                44.49%
              More involvement

                               0.00%   10.00%   20.00%    30.00%   40.00%     50.00%     60.00%   70.00%     80.00%




Source: Kostnapfel Rihtar T., Kastelic A.: Evaluation of methadone maintenance programme in
the Centres for the Prevention and Treatment of Drug Addiction in 1995, 1997, 2000. In press.




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9.4. Aftercare and reintegration


Designed implementation of the reintegration activity is assured by three big
programmes (Man Project, Hope Society, Centre for the Prevention of
Addiction) and some small programmes.

There are no data on the connectedness of unemployment and homelessness
with drugs use.

Training programmes for the work with drug addicts and persons who are close
to them are stimulated and cofinanced by the Social Chamber of Slovenia.


9.5. Interventions in the Criminal Justice System

STRATEGY FOR DEALING WITH PRISONERS WITH DRUG PROBLEMS IN
SLOVENIA’S PRISONS

Drugs, in all aspects, are a modern social phenomenon that has not stopped at
the gates of Slovenia's prisons. We do not give medical treatment to people
who have problems with drugs, but we do offer them treatment programmes.
We develop and adapt the strategy for treating prisoners with drug problems in
accordance with the development of programmes by governmental and non-
governmental organisations and with the help of experts who contribute at the
national level to the development of treatments for dependency illnesses. The
main aim of this paper is to present this strategy.

Broadly speaking the strategy for controlling problems in prisons in this area is
directed at two levels:

 preventing drugs being brought into the prison and discovering those that
  have been brought in,
 helping prisoners who have a problem with drugs.

The latter level encompasses several phases and contains several different
programmes. The treatment phases relate to the status of the prisoner, from
admission at the beginning of the prison sentence or admission on remand to
the serving of the sentence and preparation for release.




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a)   Interventions

ADMISSION PERIOD (on remand or at the start of a prison sentence)

 Low-threshold programmes of help
Individuals on methadone therapy, active drug users and people in crisis arrive
at the prison on remand or to start a prison sentence. They are first dealt with
by the health service. On a doctor's advice a withdrawal crisis may be alleviated
with the use of methadone or other medicines.
Methadone therapy is carried out in prisons on the principle of gradual reduction
to withdrawal. Only as an exception and on the advice of a doctor specialising in
treating drug dependency can an individual receive methadone maintenance
therapy.
The programme of medical help also includes raising the prisoners' awareness
of transmissible diseases such as AIDS and hepatitis, encouraging testing and
vaccinating against hepatitis B and treatment of individuals with hepatitis C by a
specialist in infectious diseases.

Medical assistance in prisons is provided by health workers who are employed
full time, by doctors in the public health care system and by psychiatrists from
the network of the Centres for Prevention and Treatment of Drug Addiction.

The aim of the medical treatment of prisoners dependent on drugs is to get
them to withdraw from the drugs and to strengthen their psychophysical
abilities.

DURING THE SERVING OF THE SENTENCE

 Higher-threshold programmes.
Higher-threshold programmes are divided into:
 education programmes,
 motivation programmes.

By means of education programmes we raise awareness among the entire
prison population about the harmful effects of drugs on health, about
development of addictive illnesses, about existing programmes of help for drug-
dependent people in society, etc.
In connection with reducing the harm caused by the use of drugs and other
hazardous behaviour, and the possibility of HIV or hepatitis infection, a
programme of health education is carried out in the form of lectures and
discussions with prisoners and prison staff. The aim of the programme is to
teach people preventative behaviour, how to overcome fear of these diseases
and behaviour against the stigmatising of the infected. For this purpose
pamphlets have been produced and distributed among the prisoners, as well as
medical advice, such as encouraging prisoners to maintain good personal
hygiene, disinfect the living quarters, use the latex gloves whenever a contact
with blood is possible, use condoms etc.




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Connected to the education programmes, the hardest part of the treatment is to
motivate the prisoners who have a problem with drugs to live without drugs, to
change their way of life from a passive, unproductive lifestyle into an active one.

The motivation programme proceeds in five phases:

1. recognising the problem,
2. thinking about a change,
3. deciding to make a change,
4. carrying out the change,
5. maintaining the change.


 High-threshold programmes
An internal decision by an individual to attempt to live without drugs means a
step up to the high-threshold treatment programmes which offer:

 regular health checks and checks to ensure that the individual is "clean" by
  means of urine tests,
 employment in workshops or employment in work therapy,
 active free-time activities depending on the interests of the individual (sport,
  music etc.),
 participation in education programmes (within or outside the prison),
 restoring and maintaining contacts with family members,
 free leave from the prison, with a gradual approach being applied,
 familiarisation with the programmes of Center for Treatment of Drug Addicts
  at the Clinical Department for Mental Health and non-governmental
  organisations and participating in them while serving the sentence (AIDS
  Foundation Robert, "Human Project" society, "Meeting" community, "Hope"
  society, etc.),
 planning for release.


The higher-threshold and high-threshold help programmes are carried out by
expert members of the prison staff – social pedagogues, psychologists and
social workers specially trained in working with people with dependency
problems. Within the working group they acquire new knowledge in the field of
dependency illnesses. Through an external expert who regularly participates at
the meetings of the working group (generally held once a month) the expert
workers can also directly discuss the difficulties encountered in practice.
Meetings of the working group are headed by an employee of the
Administration. In this way direct cooperation is established between the
Administration, the prisons and external experts and institutions in developing
and implementing a strategy for dealing with prisoners with drug problems.
The implementation of the programmes includes not only the expert workers but
also the prison officers, instructors and the organisers of educational and free
time activities.




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Prisoners enter into high-threshold programmes after reaching a so-called
therapy agreement with the experts. The therapy agreements set out the rules
and obligations for both sides participating in the treatment process.

Higher-threshold and high-threshold treatment programmes are carried out in
individual and group forms. The basis of both forms of work is a so-called
sociotherapeutic method (socio-pedagogical orientation) for dealing with
prisoners, the essence of which is to treat the prisoner as an active subject.

The goals of the treatment of prisoners with drug problems are specific and
realistically attainable. They include:
 abstinence,
 preventing return to drug use (learning to recognise risk situations),
 learning to resolve difficulties and conflicts.

Based on our experiences so far we find that prisoners only make progress
along the road to rehabilitation in an environment free of drugs, so some of the
central prisons have put in place the conditions for so-called drug-free units
within their capacities.
However, among the prison population there will remain a certain number of
people who, for various reasons, cannot or do not wish to undergo treatment of
any sort. For this part of the prison population we need to put in place
programmes to reduce the harm caused by the continued use of drugs. Needle
exchange programmes, for example, pose a challenge to the system of
implementing prison sentences, but this is part of our vision for continuing work
in this field.


b)   Drug testing

URINE TESTS
In 2000, all prisons started carrying out urine tests on the premises of prisons
(prior to that these tests were carried out in external laboratories). Before the
beginning of implementation, a workshop was organised for all institutional
medical workers who are directly engaged in the conduction of these tests. There
were also instructions produced about the procedure of taking urine (in our
environment carried out by the service of warders), about carrying out the test and
about forwarding the results of the test. (Instructions are enclosed.)
Tests shall be carried out within the framework of the following professional
issues:
     Urine tests for the demonstration of the presence of illicit drugs in the body
        may only be used in cases where the imprisoned person has signed a
        therapeutic agreement and is in the treatment process in an institution, or if
        the imprisoned person gave a written consent to the implementation of the
        test.
     The goal of the urine test shall be the self-confirmation to the imprisoned
        person that he/she succeeded in living without drugs.




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    Those persons who are making progress in the process of their own
       rehabilitation shall be tested. Testing with the purpose of achieving the
       opposite goal, i.e. to prove the "stoned condition", shall be omitted.
    All persons in methadone therapy shall be tested.
The administration shall make an umbrella agreement with the selected supplier
and prisons shall order urine tests for their own needs within a certain limit. Costs
shall be covered by the prisons. The most of the tests carried out by prisons shall
be used to demonstrate the presence of opiates.


c)     Release

-


d)     Statistics and evaluation results


Table 9.3.4.     Number of Prisoners dependent on Drugs for Individual Years in
                 relations to the Total Number of Prisoners

YEAR                                            1995      1996   1997   1998     1999   2000
Number of prisoners                             4046      3767   3882   5113     6348   6703
Number of Drug misusing Prisoners                   133   156    268      306     471    512
%                                               3,28      4,14   6,90    5,98    7,40   7,63

Source: Olga Perhavc, Central Prison Administration of the Republic of Slovenia, 2000



Table 9.3.5.     Number of Prisoners infected with the Hepatitis Virus

YEAR                                    1997              1998           1999           2000
Number of Voluntary Testing                0               214            332           191
Hepatitis A                                0                 6               4             6
Hepatitis B                                0                 8               6           19
Hepatitis C                               17                36              30           14
Total Summary                             17                50              40           39

Source: Olga Perhavc, Central Prison Administration of the Republic of Slovenia, 2000




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Table 9.3.6.     Number of Prisoners tested and Number testing positive to AIDS

Year                                        1998                 1999                   2000
Number of Voluntary testing                  208                  161                   143
Number of HIV positive                         0                    0                      0

Source: Olga Perhavc, Central Prison Administration of the Republic of Slovenia, 2000



*in this field we have close colaboration with the clinic for AIDS in the
community which provide support and counselling for HIV positive people. For
time being, no one of prisoners need their help.


e)     Specific training

In 1995 an educational program for employees and inmates which improved the
understanding of HIV and human rights was started. Seminars, training and
discussions for decision-makers, prison authorities, prison stuff and prisoners
were running in all prisons in Slovenia.

Seminars, training and discussions were provided for all prison staff and prison
authorities. Members of staff who would carry out programmes in prisons were
selected. Training was organised for the staff, focused on special skills and
knowledge.

At the moment, prison administration is intensively cooperating with
proffessionals from health authorities and all activities are going on
simultaneously. Prison administration is represented at National Committee
through their representative from The Ministry of Justice and at Coordination of
CPTDAs through their representatives from prison administrations.




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EDUCATION OF EMPLOYEES FOR THE WORK WITH DRUG ADDICTS IN
PRISONS

Basic education events: Ig - October 1995, Bohinj - December 1995, Ig - June
1996

Advanced level:
 Portoroţ - Autumn 1997. A three-day seminar in the field of addiction
  treatment within the organization UNDCP - the Višegrad group (for 20
  persons employed in Slovene prisons)
 Dolenjske toplice - June 1998. Education for the work with persons addicted
  to illicit drug use
 Sicily - October 1998. Seminar: European drug abuse training project
  (UNDCP)
 Bled - October 1998. 2nd Slovene Conference of Addiction Medicine
 Bled - October 1998. National consultation on the treatment of juvenile drug
  addicts
 Portoroţ - November 1998, A three-day international seminar: Diminishing
  the damage caused by the use of drugs in prisons within the framework of
  the Phare organization.
 Poljče - December 1998. Consultation on the programmes of drug addict
  treatment in prisons
 Education about urine tests - March 1999
 Ljubljana - 1st Slovene Addiction Conference (lectures and workshops on the
  issue of addiction treatment in prisons)
 Logarska dolina - November 1999. Education for the work with persons
  addicted to illicit drugs
 Portoroţ - December 1999. Advanced seminar: European drug abuse
  training project

There were organized meetings of working groups for the treatment of addiction
whose agenda included two parts - the educational and the problem-related
one. Lecturers are external experts in the field of addiction treatment. The
following topics were presented:
 Burn-out of therapeutists treating the addiction-related illnesses
 Treatment of recidivism
 Naltrekson in treating alcoholism
 Co-morbidity
 Poisoning with medicines
 Influence of the family on the development of addiction
 Musicotherapy in the process of treatment


Training and education of workers for the work in the departments without
drugs - April 2001 in the Dob Prison, January 2002 in the Radeče Corrective
Establishment, February 2002 in the Dob Prison (expansion of the project).




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Supervision established for the teams working in the departments without
drugs.


Starting-up of projects:
    Records on the drug addict treatment (1999).

    Beginning of cooperation with the non-governmental organization AIDS
     Foundation Robert with the goal of establishing the pilot project for
     fieldwork in prisons (March 2000). During that year preparations to the
     study visit to Bavarian prisons (Munich) were underway. In those prisons
     the fieldwork is particularly well developed. The study visit was carried
     out in October 2000.

    The fieldwork pilot project in the Ljubljana Prison (2001).

    Training within the framework of health education for the prevention of
     infections with the HIV virus, hepatitis and TB for workers and imprisoned
     persons, carried out cyclically from 1996 onwards. Every year a cycle of
     lectures and advising is carried out in all prisons.

    Outset of vaccination for workers and imprisoned persons against
     hepatitis B (April 1999).




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9.6.    Specific targets and settings

1.     Gender

Management of pregnant drug users is performing according to doctrine which
was adopted at Pompidou meetings (Council of Europe) in Strasbourg 1997,
Lisboa 1998 and Strasbourg 2000 and was prepared also by the expert from
Slovenia.

Women drug users who are in contact with specialised drug services, such as
CPTDAs and Centre for Treatment of Drug Addicts, can get support and advice
from the staff of these services. They continue their methadone maintenance
and try to reduce their methadone. Breast feeding is seen as an important
contribution to a good contact between mother and child right from the start and
is thus recommended.

Nevertheless, for many pregnant addicts the visits to their gynaecologist
represent the only contact with health services. The recognition of the pregnant
addict in these cases is difficult, especially when the addiction is denied.

The pregnancy of the addicted woman is considered in Slovenia as a high risk
pregnancy. The optimal patient care is given in the antepartum, intrapartum and
postpartum periods.

Some data from a research “PREGNANCY IN ADDICTED WOMEN ON THE
SLOVENIAN COAST” (Janja Zver,MD, Department of Obstetrics and
Gynecology, General Hospital Izola, Slovenia)

While drug abuse has been known since ancient times , nowadays we witness
escalation of problems resulting from the vast number of individuals affected.
When pregnant women are abusing drugs , they not only affect their own health
but also that of their unborn child. In USA , 5,5% of pregnant women use some
illicit drug during pregnanacy. Although we are aware of rising number of illicit
drug users in Slovenia , specially among younger population , the effects of
addiction on pregnancy have not been studied on Slovenian population to date.

The aim of study was to identify distinct behaviour patterns and conditions
associated with methadone use in pregnant women and to evaluate the
pregnancy outcomes.

Cases : 11 pregnant women attendingmethadone and prenatal programs in our
out- patient hospital unit (June 1997 – December 1999).
Controls : 524 women with negative history of drug abuse included in the same
prenatal programe (January 1997 – December 1997).
Both groups of women underwent delivery in our maternity hospital unit.




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There were performed a population- controlled retrospective study.Data were
collected from the National Perinatal Information System (NPIS). Significance of
analysed data was tested using the Student t-test where p0.05 was considered
significant. Diffrences between attributive prameters were tested by the Chi-
Square and determined by the Fischers exact test.

Two groups of pregnant women in study were found to be different in age,
marital status and smoking habits, while they did not differ in gestation at 1st
visit, number of a prenatal visits, parity and hospitalization.


Table 9.6.1.       Mean values with standard deviations or percentages

                                    Cases                Controls
                                                                             P
                                    N=11                  N=524
Age (years)                        23,5  3,7           28,1  3,7         0,002
Single (%)                           54,5                 10,5             0,001
Smokers (%)                          72,7                 14,9             0,001
Gestation week at 1st visit (%)    16,9  6,0           11,4  4,9          NS*
Prenatal visits (N)                7,4  3,7            8,7  2,6           NS
Primigravida (%)                     81,8                 54,4              NS
At least 1 hospitalization (%)       45,5                 27,2              NS

Source: Janja Zver Skomina
*NS=non- significant



Addicted pregnant women in our study had significantly higher rate of cesarean
sections and small for gestational age newborns. No significant differrences
were observed in the rate of prenatal analgesics use, duration of delivery,
breech delivery rate of pretermdeliveries.




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Table 9.6.2.     Mean values with standard deviations or percentages

                                 Cases                  Controls
                                                                             P
                                 N=11                    N=524
Parenteral analgesics (%)         36,4                    14,7              NS*
Duration of delivery (%)        3,6  2,6               4,8  2,9           NS
Breeech delivery (%)               9,1                    2,5               NS
Cesarean section (%)              27,3                    8,5               0,03
Small for gestation (%)           54,5                    4,2              0,001
Preterm delivery (%)               9,1                    5,0               NS

Source: Janja Zver Skomina
*NS=non-significant



Previous studies have confirmed, that babies born to women attending
methadone program are small for gestational age. However, beside methadone
use, broader spectrum of possible parameters influencimg pregnancy should be
considered.
In the present preliminary state of the study, a comparatively small group of
addicted women was compared with the control group of pregnant womenwith
no history of drug abuse. Nevertheless, severalconclusions can be drawn from
the analysedsamplewith high degree of significance. Addicted women tend to
conceiveat younger age and bulk of them do not give up smoking during
pregnancy. More than half of includedaddicted women were un married, which
also indicates their strainedgeneral living circumstances.The pregnancy
outcome results with significantly gestational age newborns compared with the
control group indicate that methadone use has an impact on pregnancy.
However, considering the mentioned harmful behaviour patterns observed,
methadone use itself cannot be exposed as the sole marker which unfavorably
affects pregnancy in addicted women.Bearing in mind that the risks to mother
and fetus in methadone maintenance are far fewer than those associated with
street drugs, as well as the related lifestyle dangers, methadone is the
treatment of choise in addict pregnancy. Considerable attention, however,
should also be devoted to parenting education, in order to improve the
expectant addict lifestyle.


2.    Parenthood and drug use - children of drug users

Therapeutic interventions include group of relatives in all Centres for the
Prevention and Treatment of Drug Addiction, in the Centre for Treatment of
Drug Addiction at the Clinical Department of Psychiatric Clinic in Ljubljana, in
therapeutic community and NGOs.




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3.   Parents of drug users

Therapeutic interventions include group of relatives in all Centres for the
Prevention and Treatment of Drug Addiction, in the Centre for Treatment of
Drug Addiction at the Clinical Department of Psychiatric Clinic in Ljubljana, in
therapeutic community and NGOs.

Some NGOs for parents of drug users are organising meetings and can be
contacted on three different specially-created parents‟ hot-lines for information
and in crisis.

4.   Drug use at the workplace

In 1996 the model programme of drug abuse prevention among workers was
launched by the Institute of Public Health of Slovenia together with the Ministry
of Work, Family and Social Affairs and as a part of ILO international project. The
overall objective of the project was to develop an adaptable, acceptable and
feasible model programme for workplaces with the potential for deployment.
Data collection on drug problems in workplaces contributed substantially to
success of the project planning.

5.   Drug use in prisons

Central Prison Administration in 1996 set up a project group which started to
collaborate with the Ministry of Health and other experts. At the same time first
draft of guidance for treatment for drug misusing prisoners has been written and
prepared for discussion at the national level.

Prevention of infections in prisons

In 1987 the Ministry of Justice with the assistance of Ministry of Health
formulated guidelines for how to approach HIV epidemic in prisons. Prisoners
have the same right to adequate health services as the population in the local
community, including voluntary, confidential and anonymous HIV testing.

Considering that HIV prevention is an urgent objective among prisoners,
especially among those injecting drugs, a prevention strategy for prisons was
established. It has been based on recommendations of the Council of Europe
and adopted to the local society through cooperation with the authorities
responsible for the development of prevention measures in the medical field
and collaboration with the national prison administration. This resulted in a
booklet
»HIV in prisons«, availability of free condoms and establishment of a monitoring
system of condom use.

In the future continuation of prevention activities is planed, collaboration with
other authorities and evaluation of the programme.




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10. Quality Assurance

10.1. Quality assurance procedures
As already mentioned, monitoring and evaluation are still in its infancy in
Slovenia. The necessity of evaluating drug demand reduction projects and
programmes is becoming, however, more and more accepted fact among the
professionals. Evidence is often required by policy makers to further support
DDR projects. Those who are providing funds more often require planning of
evaluation and monitoring as a part of a project.


10.2. Treatment and prevention evaluation

Prevention evaluation

There are no new data on this topic.

Model project Drug and Alcohol abuse at a workplace has implemented
evaluation right from the start. The Institute of Public Health of Slovenia has
designed guidelines and mechanism for evaluation of drug and alcohol abuse
prevention programmes at the workplace in 1998. When the Institute, in co-
operation with the employers, decided to take appropriate preventive or
remedial actions against alcohol and drug problems in the workplace in six
Slovenian enterprises, they did so with the intention that the established
programmes would be beneficial.


Evaluation of methadone treatment

The comparison study of the quality of the methadone maintenance
programme in 1995, 1997 and 2000 has been done to evaluate methadone
maintenance programme as one of the services of CPTDAs.

According to the new directives originating in the Spring of 1995, the
methadone maintenance program is operating as one of the services of the 15
Centres for Prevention and Treatment of Drug Addiction in the Republic of
Slovenia.
The authors collected data regarding the quality of the program by the use of a
questionnaire in the research in 1995, 1997 and in May 2000.

Data regarding the quality of the programme were collected by the use of a
questionnaire. In the 1995 questionnaire was completed by 267 clients in the
maintenance program (51% of all participants in the program), while in the 1997
questionnaire was completed by 729 clients (71.8% of all participants in the



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program). The questionnaire was completed in the 2000 by 845 clients in the
maintenance program (63.7% of 1326 participants in the program).

Among those included in the program the number of female participants
increased from 22.3% to 23.5%. A slight change in the educational level and
employment of the participants was also noted.

The number of participants who were regularly employed increased from 21.8%
to 28.6%, while the number of those who worked occasionally decreased from
34.2% to 25.5%.

Comparison data of clients in the Methadone Maintenance Programme in
1995, 1997, 2000


Figure 10.2.1. Types of methadone treatment programmes




                                6%
                                           15%




                79%
                                                    short detox (up to 1 month)
                                                    detox (up to 6 month)
                                                    maintenance




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Figure 10.2.2. Gender of clients who participated in the methadone
               maintenance programme, 1995, 1997 and 2000

                                             Gender
                              77.7%                80.0%         76.5%
         80.0%
         70.0%
         60.0%
         50.0%
          40.0%      22.3%
          30.0%                            20.0%
                                                                23.5%
          20.0%
          10.0%
                                                                           Male     Female
            0.0%
                                                                        Female      Male
                   1995
                                    1997
                                                       2000




Figure 10.2.3. Average age


                                           Average age

                             26.9
                                                                             26.6
              27

            26.5
                                                    25.5
              26

            25.5

              25                                                                        1995
                                                                                        1997
            24.5
                     1995                    1997                   2000                2000




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Figure 10.2.4. Level of education

                                                     Level of education


                                  1.0%
             university
                                     3.1%
               college
                                                                                                    36.4%
      secondary school
                                                                                                             2000
                                                                                     27.9%                   1997
       technical school
                                                                                                             1995
                                                                                  27.3%
     elementary school

                                          4.4%
            unfinished

                    0.00%         5.00%     10.00% 15.00% 20.00% 25.00% 30.00% 35.00% 40.00%




Figure 10.2.5. Employment


                                                          Employment


                                                   8.1%
                    other
                                                               14.4%
                 studying
                                                                                     25.6%
                                                                                                             2000
          occasional work
                                                                                                             1997
                                                                                   23.2%
                                                                                                             1995
              unemployed
                                                                                                28.6%
      full-time employment

                          0.00%      5.00%       10.00%    15.00%      20.00%   25.00%     30.00%   35.00%




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Figure 10.2.6. Testing on HCV




                         13.59
                 11.15



                                                 75.25              yes
                                                                    no
                                                                    did not know




Figure 10.2.7. Vaccination against hepatitis B




                         6%       6%

                                                                          yes
                                                                          no
                                                                          do not know
               32%                                         56%
                                                                          no response




Source: Kostnapfel Rihtar T., Kastelic A.: Evaluation of methadone maintenance programme in
the Centres for the Prevention and Treatment of Drug Addiction in 1995, 1997, 2000. In press.




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10.3. Research


a)    Demand reduction research projects:

Global approach on drugs, Copernicus programme contract no IC 15 CT 98 10
14

Objectives: To develop a social approach to the drug phenomenon, although
the empirical research has enlightened the decisive social factors of drug
development. To build a social diagnosis tool for drugs problems in the field
based on the research findings and global approach.


b)    Relations between research and drug services

    Patrik Kenis, Flip Maas, Robert Sobiech: Institutional Responses to drug
     demand in central Europe. An analysis of Institutional Developments in the
     Czech Republic, Hungary, Poland and Slovenia.

Objective: Study investigates in detail the institutional response of demand
reduction activities in four countries, their strenghts and weaknesses on a
country by country basis as well as in the form of cross country comparisons. It
thus provides a wealth of information for policy makers, both in terms of
availability of services and areas for improvement.


    Vito Flaker, Vera Grebenc, Nino Rode, Janko Belin, Dragica Fojan, Alenka
     Grošičar, Ilonka Feher, Mateja Šantelj, Andrej Kastelic, Darja Zupančič,
     Zlato Merdanović: Landscapes of Heroin Use in Slovenia: Harm
     Reduction Point of View (Preliminary Research Report)


This research is a part of the “TECHNICAL ASSISTANCE TO DRUG DEMAND
REDUCTION” Phare project. Together with the Czech Republic and
Macedonia, Slovenia was involved in a regional sub-project of HARM
REDUCTION. Our part of the research was based on the Rapid Assessment
and Response (RAR), developed by Stimms and Rhodes for the United Nations
and the WHO (1998). The concept of our research is based on the same
assumptions, and it has the purpose of achieving similar results, i.e. to provide
relatively expedient but still accurate ways to create a body of knowledge which
can support the development of the responses and services. The research was
also linked to the other activities of the mentioned project.

The research draws on the tradition of action and qualitative research, which
School for Social Work has developed over the last decades. On the basis of
the experience gained from research conducted previously, for example, Drugs



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and Violence (Flaker, 1993), a number of initiatives in harm reduction have
been proposed, this methodology being highly appropriate for new insights in
the area of drug use, developing organisational experiences, as well as for
raising the awareness of both the professional and general public.

Goals of the research were stated as follows:
- to provide a knowledge on drug use in different settings, different styles,
  cultures; to get to know everyday life circumstances of drug users, their
  social circumstances, quality of life, hazards as well as strengths of their
  survival techniques;
- to asses the services available to people with problems related to drug use
  as well as the effects of other social reactions to drug use;
- to enable the processes which will fill the gaps in present provision as well
  as promote changes that will enable present structures to offer more
  adequate services;
- to promote more pragmatic and realistic attitudes in decision making, service
  providing and general audiences.


Table 10.3.         Risk associated with the sharing of the equipment: factors, rates,
                    points of risk and risk reduction
                                    2
Factors                      Rate             Points of risk               Factors of risk
                                                                           reduction
Awareness                    Big              Beginners                    Fear of hepatitis
                                              Withdrawal                   Good availability of
                                              Fatalism of junkies          needles
Availability of              Good             Nights and weekends          Outreach
equipment                                     Deprecatory attitudes in     Services of Stigma and
                                              pharmacies                   AFR
                                              Fear of stigmatisation
                                              Availability is bad on the
                                              deep periphery
Sharing of needles and       Rare             Beginners                    Rules in group use
syringes                                      Periphery                    Extent of individual use
                                              Haphazard use
                                              Group use
Sharing the spoon and        Common           Scrounging filters           Rules in the group use
filters                                                                    (one who does not have
                                                                           a syringe takes last)
                                                                           Extent of individual use
Backloading and              Almost non-      Exist as a means of          Fear of being cheated
frontloading                 existent         transport not dealing        Users see it as stupidity
                                              Some places (rarely)
                                              beginners
Contaminated water           Not often        During group use

Source: Vito Flaker




2
    Estimate is arbitrary and for orientation purpose.



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It appears that the level of awareness among Slovenian intravenous users is
quite high, accessibility of needles and equipment is very good, so that in
normal circumstances there is not much sharing of needles and syringes. Risk
is higher mostly in beginners, which in their careers as users are in a position of
not caring at all. Risk is also higher in smaller towns, where accessibility to
needles is poorer and the fear of stigmatisation is higher. Other problematic
issues involve getting a needle at night and the attitude of pharmacists towards
users. The sharing of spoons and filters in group use is widespread and users
are mostly not aware of the risk involved. We also identified specific features in
the user culture which reduce the risk. In addition to the fact that it is important
that needles and syringes are accessible, the work done by non-governmental
organisations, field workers, where available, and centres for the treatment of
addicts plays an important role. Though group use increases the risk of
infection, it reduces the risk of death or severe injuries in the even of an
overdose.

Preliminary conclusions of the research

This report has presented the part of the material which was obtained during the
research and to some extent also analysed. The research is not finished yet,
though. In the next phase they aim to achieve two things.
Vito Flaker etc: “In mapping of drug use we will include data which we have not
up to thin point and continue our analysis. Our analysis, as the reader would
have probably noticed, stopped on the entirely descriptive and interpretative
levels. We made an attempt to summarise and arrange the material in order to
tell the story we were told by our respondents. This may perhaps be enough for
the sociological research paradigm, but it certainly is insufficient for social work
one, where the results of the research must serve the purpose of a more
concrete action, interventions and care. Thus, in the following months we are
planning to supplement the map and catalogue we created with signposts,
itineraries and instructions for use.

In any case, on the basis of impressions and individual ideas which sprang to
our mind while processing the data, at this time we can draw some conclusions
and possible guidelines aimed at drug-related harm reduction.

The first conclusion which can without hesitation be derived from our research
is that the concept of harm reduction is unjustifiably usually limited to the health
consequences of heroin use. Social consequences are also present and
important in the planning of a harm reduction strategy. The loss or lack of
housing, job, friends, contacts with relatives, as these were described, can
undoubtedly be destructive effects, which can emerge as a consequence or at
the least as an accompanying phenomenon of heroin addiction. We can
assume that positive measures which would mitigate the consequences of
stigmatisation and social isolation could take the form of positive discrimination,
that is, measures which would in principle improve the status of users to provide
them with opportunities equal to those available to other people (e.g., facilitated
access to employment, housing, etc.). On the other hand, we can assume the



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introduction of concrete measures intended for those users who find themselves
in material hardship (for example, as users themselves proposed, shelters for
homeless users, special public work or workshops, social premises and
socialising with normal peers). These measures could have a multifold effect.
They would dilute the role of an addicted user because users would be enabled
to take on different roles, which diminishes the domination of the role of a user,
they would provide a stronger material basis for basic support and also self-
confidence which as a result would reduce both health (infections, injuries) and
social (impoverishment, crime, prostitution) risks generated by the social
consequences of addiction; on the general level, this would contribute to de-
stigmatisation and de-ghettoisation of addicted users and drug users as a
whole.

The second conclusion that can be drawn on the basis of impressions is that
the understanding of heroin use has so far been excessively based on
individualist issues. Our data indisputably point at a whole set of phenomena
which are explicitly collective (beginning of drug use, rules which govern use,
the entire complex of the market and dealing, the knowledge of the effects and
risks of drugs, etc.). Furthermore, the group, or to put it better, community
aspect of use is much more important in the case of beginners and
experimenting users, while the style of “mature users” is more individualised
and socialising is more atomised. Habits are formed on the individual level and
internalised. The community aspect is also very important in abstainers,
particularly those who return from therapeutic communities. We determined that
contacts with services are less frequent and the need for concrete professional
help is lower or less pressing in beginners, experimenting and controlled regular
users. For this reason, they are not accessible as individual clients of these
services. This is also the advantage of the group and field approaches over the
individual and therapeutic approaches. In this sense, we can envisage the
necessity of developing such approaches which will function between groups
and user networks, which will influence their culture, strengthen their values and
practices, and which reduce risks. Concretely we have in mind projects which
would cover a whole neighbourhood, including other important actors in the
community rather than just users.

The third general conclusion is that in this type of intervention we cannot merely
rely on educational approaches. Teaching and awareness raising, although
conducted within a community and among users themselves, are not enough if
the measures do not include concrete and actual interventions, which bring
about different practices. We can assume that on the basis of finding out that
circumstances or situations in which users find themselves are more crucial for
a specific activity or practice than personal motivation or interest (e.g., both at
the beginning and termination of drug use). For this reason, interventions must
be aimed at the concrete and actual contexts of use (e.g., provision of antidote
for preventing overdose, provision of premises for social contacts, provision of
condoms). In addition to the already-known intervention of harm reduction (e.g.,
safe injecting, sterile equipment, premises for safe use), attention must be
devoted to the withdrawal crisis as one of the key moments in the life of an



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addicted user. This calls for the development and furthering of our
understanding of the phenomenon of withdrawal, as well as for conducting a
dialogue with users, search for ways of lower-risk action and management of
withdrawal, and offer them realistic opportunities for alleviating the withdrawal
crisis.

Our research arrived at the construction of the concept of fundamental
misunderstanding. This concept, which calls for further elaboration, is important,
since it can serve as a guideline in the understanding the differences among
different types of offer and in the planning of response to the various type of
distress of users and to social problems. The essence of the fundamental
misunderstanding is that either parents, professionals or other actors want to
help when the user does not want help, or that they want to help in an entirely
inappropriate manner. At its best, this may result in the fact that all the effort
was in vain, while at its worst, it may generate disappointment and distrust on
the part of both parties, a family drama, abandonment of help, where the user
resorts to the role of a junky and to destructive behaviour. This is why the
assessment of the needs and desires of users, as well as of their life context
and the “prompt dosage” of help, at the right time and to the appropriate extent,
is of vital importance for the construction of services and in the planning of
individual measures. In this sense low-threshold and high-threshold services
must be looked as at complementary services, as well as continued services,
meaning that transition must be possible between them, where we need to
accept the necessity and insufficient level of development of low-threshold
services in order to develop them with a sensitivity for the concrete reality in a
specific environment with respect to both individual and group needs of users.
This means that the knowledge derived from research and ethnography is of
exceptional importance for the development of these services, and that low-
threshold interventions are always also research interventions and vice versa,
that they must be derived from the assessment of needs in the community.”


c)   Training in demand reduction research

A lot of trainings for professional working with drug users is organized in a form
of seminaries. Several meetings organized in cooperation with Pompidou Group
and Phare Programmes have been used as a training and thus professionals of
all specialities working with drug issues have been invited to these meetings.

Since 1995 several trainings and seminaries were organized for the
professionals working with drug users:

 Fifteen training seminaries for the professionals working at CPTDAs and
  Health Centres from all regions have been organized by The Ministry of
  Health. Health workers from prisons and psychiatric hospitals, social
  workers, professionals in Centres for Social Care, psychologists and
  representatives of the Pharmacy Chamber have also been invited.




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 The Ministry of Internal Affairs organized trainings for police professionals, in
  particular those working with drug users.
 Almost ten training seminaries have been organized for professionals in
  prisons by the Prison Administration in cooperation with the Ministry of
  Health.

Basic training for professionals of all specialities working with drug users is
organised every year by the Ministry of Health in cooperation with Coordination
of CPTDAs. Seminaries on counceling, motivational interview, woman specific
issues, team work, relaps prevention and staff burn-out are planned to be
organized.
Addiction prevention is increasingly incorporated into teacher training
programmes as an issue of special importance. The institutions for the training
of teachers are increasingly seeking cooperation with the addiction prevention
experts.

There is a need of more continuous form of training at all levels. The use of
distance education was discussed as a form of education for volunteers and
outreach workers.


Seminar about the safety road traffic: The seminar was interdisciplinary,
organised by different institutions. Seminar's objective was to clarify the
availability of drivers for driving the car when they are under the influence of
different medicines, including methadone as a substitution therapy.

DRTSP II. : The aim of the project was developing module of postgraduated
educational programme under the supervision of Pompidou Group of the
Council of Europe. A number of university professors have prepared a
curriculum for postgraduate education for professionals from different fields.

The Governmental Office for Drugs: a yearly conference of the Slovenian LAG :

The conference was held in Celje. Its objective was to find out how to analyze
conditions in the local community and how to organize a joint action in the field
of drugs on local level. The guest speaker from Great Britain talked about their
experience in that matter.

The Education Office: the National programme Council for the Healthy
School Children: The revision of preventive programmes in Slovenian primary
and secondary schools with an aim to prepare evaluation methods and
supervision over the programmes.




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10.4. Training for professionals

MASTERS DEGREE PROGRAMME – University of Ljubljana, Slovenia

Drug demand Reduction in Slovenia and further a field is a subject area that
combines findings from the fields of medicine (psychiatry and public health),
social work, social science, education, criminology and epidemiology, pharmacy
and many more. The rapid and extensive development of this field, its influence
on the quality of life and its importance in society demand a high-quality and
modern Postgraduate Study Programme for the acquisition of appropriate
knowledge in the areas of individual disciplines at the University of Ljubljana.

Drug Demand Reduction is a very broad subject and includes concepts such as
prevention, early intervention, treatment, rehabilitation and policy planning.
Until now topics for the new Postgraduate Programme have been developed in
various different Faculties of the University of Ljubljana; the sensible action to
take is therefore to combine existing or supplemented postgraduate teaching,
both organisationally and contextually, which would also enable the combining
of lecturers and the bringing-together of researchers working within member-
bodies of the University of Ljubljana and with external Research Institutes.


The Aims of the Postgraduate Programme include:

      To communicate expertise, scientific knowledge and „good practice‟
       relating to Drug Demand Reduction through training and education at a
       European level

      To impart information on a range of interventions in the fields of
       treatment, prevention, policy and research

      To deliver special knowledge germane to the Addictions field




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Postgraduate studies in the area of Drug Demand Reduction are predominantly
organised and carried out by the:
                     Faculty of Medicine
                     Faculty of Education
                     School of Social Work
                     Faculty of Social Science
The Faculty of Medicine, Faculty of Social Science and the Faculty of Education
together with the School of Social Work plan to combine all the areas of Drug
Demand Reduction that they teach. The Faculties of Law & Criminology,
Pharmacy, Sport and Art (Clinical Psychology) will contribute individual classes
closely connected with the programme.

Employees at Research Institutes (Anton Trstenjak Institute and the Institute of
Public Health) will also take part in the implementation of the individual sections
of the programme, through cooperation with specially trained and qualified
tutors at the University of Ljubljana.




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                               KEY ISSUES




 PART 4

KEY ISSUES




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11. Infectious diseases

11.1. Prevalence of HIV, HCV, and HBV among injecting drug
      users
HIV

Slovenia has a low level HIV epidemic. The prevalence of HIV infection has not
reached 5% in any population group. Rapid HIV infection spread seems not to
have started yet among injecting drug users. During the period from 1996 to
2000 HIV prevalence consistently remained below 1% among confidentially
tested injecting drug users treated in the network of Centres for Prevention and
Treatment of Illicit Drug Use. During the same period no HIV infection cases
were detected by voluntary confidential testing among injecting drug users
demanding treatment for the first time. Similarly, during the period from 1995 to
2001 HIV prevalence among injecting drug users demanding treatment for the
first time in two of these Centres (Ljubljana and Koper) and consenting to be
tested unlinked anonymously for HIV surveillance purposes consistently
remained below 1%. Regrettably, no information on HIV infection prevalence is
available from needle exchange or other lower threshold harm reduction
programmes nor from community based surveys among injecting drug users.

Average annually reported newly diagnosed HIV incidence rate during last five
years (1997 to 2001) has been 6.5 per million population (8.0 per million in
2001) and reported AIDS incidence rate 3.5 per million population (2.5 per
million in 2001). During the same period the reported newly diagnosed HIV
incidence rate among injecting drug users calculated per total population has
remained below 1.0 per million population (one case in 1997, two in 1998, no
cases in 1999, and one case in 2000 and 2001) and AIDS incidence rate below
0.5 per million population (no cases in 1997, 2000 and 2001 and one case in
1998 and 1999). In contrast to relatively reliable AIDS reported data the
information about reported newly diagnosed HIV infection cases does not
reliably reflect HIV incidence.


HBV

During the period from 1996 to 2000 the prevalence of antibodies against
hepatitis B virus (HBV) among confidentially tested injecting drug users treated
in the network of Centres for Prevention and Treatment of Illicit Drug Use
ranged between 2.6% to 6.6% (2.6% in 1996, 2.7% in 1997, 4.3% in 1998,
6.6% in 1999 and 5.3% in 2000). During the same period the prevalence of
antibodies against HBV detected by voluntary confidential testing among
injecting drug users demanding treatment for the first time ranged from 0% to
3.8% (0% in 1996, 3.8% in 1997, 1.9% in 1998, 0% in 1999 and 3.3% in 2000).




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Unfortunately it is impossible to distinguish between the prevalence of
antibodies against HBV and the prevalence of current HBV infection (HBsAg).
In 2002 the data collection has been revised. Information on different HBV
infection markers will be collected (anti HBc, anti HBs, and HBsAg).

During last 10 years (1992 to 2001) the reported acute HBV infection incidence
rate in the Slovenian population decreased from 4.5/100.000 population in 1992
to 1.0/100.000 population in 2001. Due to underreporting, HBV reported
incidence rates greatly underestimate the burden of the disease. Nevertheless,
the downward trend should be noted. For the period from 1997 to 2001
information on transmission route is available for a minority of cases. Injecting
drug use was implicated in 0% to 25% of those cases.


HCV

During the period from 1996 to 2000 the prevalence of antibodies against
hepatitis C virus (HCV) among confidentially tested injecting drug users treated
in the primary health care network of Centres for Prevention and Treatment of
Illicit Drug Use ranged from 20.8% to 30.1% (30.1% in 1996, 21.1% in 1997,
20.1% in 1998, 21.2% in 1999 and 20.8% in 2000). The prevalence among
short term injecting drug users (less than 2 years) ranged from 0% to 13.3%.
That is clearly lower than among longer-term users (from 21.9% to 38.3%).
During the same period the prevalence of antibodies against HCV detected by
voluntary confidential testing among injecting drug users demanding treatment
for the first time ranged from 8.3% to 32.1% (32.1% in 1996, 12.7% in 1997,
12.5% in 1998, 13.3% in 1999 and 8.3% in 2000). Information on the proportion
of chronic HCV infections among these individuals is not available.

During the period from 1994 to 2001 annually reported acute HCV infection
incidence rate in the Slovenian population ranged between 0.6/100.000
population in 1994 to 2.6/100.000 population (in 1998 and 2000). Due to
underreporting, HCV reported incidence rates greatly underestimate the burden
of the disease. For the period from 1997 to 2001 information on transmission
route is available for a minority of cases. Injecting drug use was implicated in
40% to 100% of cases (67% in 1997, 1998, and 2001; 40% in 1999; 100% in
2000).




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11.2. Determinants and consequences
Injecting risk behaviour

The spread of infections (HIV, HBV and HCV) among injecting drug users is
mainly determined by injecting risk behaviour, notably »needle sharing«.
Transmission is also possible through sharing other injecting equipment, not
just needles and syringes.

In 1996 a behavioural surveillance approach to monitor risk behaviour trends
among injecting drug users has been established in Slovenia. We started
collecting information about a few injecting risk behavioural indicators within the
network of Centres for Prevention and Treatment of Illicit Drug Use. Questions
about sharing needles and syringes and other equipment were added to the list
of information collected during annual surveys of treated clients and at first
treatment demand. Some results for clients demanding treatment for the first
time are presented in Table 11.2.1. It is worrying that the proportion of current
injectors (injecting last month) reporting sharing needles and syringes during
the month prior to treatment demand has not been decreasing recently.


Table 11.2.1. Injecting risk behaviour among IDU clients demanding treatment
              for the first time in the network of Centres for Prevention and
              Treatment of Illicit Drug Users

                                                         1996      1997     1998    1999    2000
Ever injected illicit drugs (IDU) - bases                 238       385      405     298     272
 Ever having shared needles & syringes                  52.5%     62.3%   60.7%    54.7%   48.9%
 Ever having shared other equipment                     37.0%     70.9%   74.6%    72.5%   70.6%


Currently (last month) injecting illicit drugs
                                                          198       311      322     260     231
- bases
  Shared needles & syringes last month                  18.2%     32.2%   30.4%    25.8%   28.1%
 Shared other equipment last month                      24.2%     47.9%   43.2%    40.0%   42.0%

Source: Irena Klavs, Institute of Public Health



Obvious limitation of such “crude” behavioural surveillance information is the
questionable validity of self reported information. However, presumed
consistency of data collection methods, relative feasibility of collecting such
behavioural surveillance information and appropriateness of such an approach
to monitoring trends is convincing.

Regrettably, reliable injecting risk behavioural data from repeated community
surveys among injecting drug users is not available.




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Sexual risk behaviour

Sexual transmission of HIV and HBV infections among injecting drug users and
their sexual partners is also important, while sexual transmission of HCV is
thought to be low.

As for higher risk injecting behaviour, a behavioural surveillance approach to
monitor sexual risk behaviour trends among injecting drug users has been
established in Slovenia in 1996. We started collecting information about a few
sexual behavioural indicators within the network of Centres for Prevention and
Treatment of Illicit Drug Use. Questions about number of partners, condom use
and trading sex for drugs or money were added to the list of information
collected during annual surveys of clients and at first treatment demand. Some
results for clients demanding treatment for the first time are presented in Table
11.2.2.

Obvious limitation of such “crude” sexual behaviour surveillance information is
the questionable validity of self reported data. However, presumed consistency
of data collection methods, relative feasibility of collecting such behavioural
surveillance information and appropriateness of such an approach for
monitoring trends is convincing.

In 2002 the sexual behaviour indicators list has been revised. Unfortunately, the
collection of information about ever having received money or drugs for sex has
stopped. However, we started collecting important information about the sexual
link between injecting drug users and non-injectors by directly asking questions
about sexual partners non-injectors during last year.




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Table 11.2.2. Sexual behaviour among IDU using clients demanding treatment
              for the first time in the network of Centres for Prevention and
              Treatment of Illicit Drug Users

                                                      1996    1997    1998    1999    2000
Clients reporting sexual partner(s) last
                                                       124     295     322     261        255
year - basis
  1 partner                                          70.2%   56.3%   52.5%   51.7%   59.6%
     2-4 partners                                    22.6%   30.9%   33.8%   36.0%   28.0%
     5-9 partners                                    3.2%    7.7%    9.9%    9.3%     9.8%
     10+ partners                                    4.0%    5.0%    3.7%    3.1%     2.7%


Used condom during last sexual intercourse           13.4%   25.4%   25.6%   30.9%   25.3%
Having received money or drugs for sex               3.0%    3.3%    0.9%    1.4%     1.5%

Source: Irena Klavs, Institute for Public Health



Regrettably, reliable sexual risk behavioural data from repeated community
surveys among injecting drug users is not available.



11.3. New developments and uptake of prevention, harm
      reduction and care


1.       Prevention

In the field of prevention, the development of a network of local action groups is
foreseen which will accelerate the development of preventive programmes in
local communities. At the level of regions, the formation of Regional Action
Groups is planned which will connect local groups in a broader area, in
accordance with the Regions Act, which is in the parliamentary procedure.
There is also foreseen to carry out a more detailed evaluation of preventive
programmes in the field of prevention of addiction. The programmes which are
currently going on in various environments will be evaluated and the publication
"Good Practice" will be prepared. A part of the plan is also to establish a basic
information network for educating young people about drugs and here the focus
will be predominantly placed on risk groups. The education will embrace not
only the youth, but also their parents and pedagogues, and within this
framework also programmes for non-school children will be developed. The
prevention of drug use will be logically connected with the prevention of alcohol
and tobacco consumption, and common activities will be carried out in this field.
In the Slovene Army, modern methods of preventive work with soldiers in
military service will be introduced. It is also planned to stimulate the creation of



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special programmes in work organisations. Special attention will be devoted to
children of addicted parents. For every budgetary period an action programme
will be adopted for all areas of treatment of drug users.


2.     Treatment


The development of the network of Centres for the prevention and treatment of
drug addiction will be continued from the aspect of contents. If necessary, the
network will be expanded and new, advanced methods of addiction treatment
will be introduced, as well as connection with the other governmental and non-
governmental programmes of addiction treatment in Slovenia will be continued.
The outset of operation of the national Centre for Treatment of Drug Addicts
with 35 bed s is planned in May 2002. The capacities for the treatment of young
people in the form of a hospital treatment as well as in the form of a daily,
outpatient treatment, day hospital, prolonged treatment for patients with multiple
diagnosis will be assured and detoxification.

Bigger attention will be devoted to risk groups - programmes adjusted to women
and their treatment. Special programmes of treatment in prisons will be
developed and they will be compatible with the already existing treatment
programmes outside prisons. Particular attention will be focused on the
prevention and treatment of the infection with the HIV virus, hepatitis C and B,
and tuberculosis, as well as to education. A consistent vaccination of drug
addicts against hepatitis B will be carried out in all programmes of addiction
treatment. Special attention will be paid to the treatment of homeless persons
having troubles with addiction.


3.     Programmes of social assistance

In the following years we will devote a lot of attention to the prevention of social
exclusion and labelling of drug users. With special programmes and through the
network of public authorisations, the network of Social Work Centres can
substantially contribute to the elimination of social threat of drug users. In this
field we will fight for the reduction of social exclusion, further development of
services for the assistance to socially endangered drug users, assurance of free
entrance to the programmes of social assistance, and establishment of the
network of daily centres, therapeutic communities, communes and other forms
of social assistance to drug addicts.

4.     Harm reduction activities

A lot of attention is being devoted to harm reduction: by stimulating new
programmes in the towns where no such programmes exist and by expanding
the already existing programmes.




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In the following years we predominantly wish to:
 Develop the network of harm reduction programmes (outreach, exchange of
    needles and counselling);
 Prepare the professional, political, legal and technical basis for the
    introduction of the pilot project "Safe Injection Rooms";
 Examine the possibility of introducing a test heroin maintenance programme;
 Stimulate pharmacies to implement the drug exchange programme;
 Strengthen the information about a safer drug use between the intravenous
    users;
 Strengthen the role of drug users as partners in various processes of
    planning and decision-making.




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12. Evolution of treatment modalities

12.1. Introduction
We will explain the status of treatment services for problem drug users at the
beginning of the 1990s, especially from health sector and low threshold sector.
Data from social sector are missing.


12.2. Legislation/regulations that had an effect on a treatment
      provision
Health Care and Health Insurance Act (Official gazette 9/92)
Prevention of the Use of Illicit Drugs Act and Dealing with Consumers of Illicit
Drugs Act (Official gazette 98/99)

   Article 8 defined that the treatment of consumers of illicit drugs shall be
    carried out in the form of hospital and outpatient clinic treatment
    programmes approved by the Health Council at the Ministry of Health of the
    Republic of Slovenia:
“The treatment referred to in the preceding paragraph shall be carried out by
natural and legal persons who fulfil the conditions defined for the performance
of medical activities in accordance with the act governing medical activity.
In accordance with this Act, treatment shall also be deemed to be maintenance
with methadone and with other substitutes approved by the Health Council.”

  Article 10 defined Social security services and programmes for the
   resolution of social problems related to the consumption of illicit
   drugs:
“Social security services intended for the prevention and elimination of social
hardship and problems related to the consumption of illicit drugs provided in the
form of public services shall in particular comprise social prevention, emergency
social assistance, help for individuals and help for the family.
The services specified in the preceding paragraph shall be provided in
accordance with the act governing social security and in accordance with norms
and standards prescribed by the minister responsible for social affairs.”

►Developments in outpatient illicit substance abuse treatment (ISAT)
over the 1990s and 2000

In the early nineties, with the expansion of drug use and drug addiction also the
prescribing of methadone started, first in the Vojnik Psychiatric Clinic (Dr
Novak) and later on in the littoral (Dr Krek).




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Due to the increasing number of those who searched for such kind of treatment
from the entire Slovenia, the need for structuring a programme and organising
at the state level occurred.
The methadone maintenance programme is one of the fundamental treatment -
not only harm reduction programme - in current drug policy that aims to protect
the users of illegal drugs by increasing the number of users who make contact
with the medical service, remain in treatment or join higher threshold
programmes.

The Health Council at the Ministry of Health has adopted national guidelines
for management of drug addicts, including methadone maintenance harm
reduction strategy, in April 1994. The recommendations concerning treatment
of drug addiction were adopted containing instructions for general practitioners,
for emergency procedures, the hospital treatment of addicts for diseases
connected or unconnected with drug dependence, for psychiatrists, territorial
defence doctors and those dealing with prisoners, and for other situations in
which medical personnel come across unauthorised drug taking.
The recommendations give instructions about identification of drug use, the
diagnostic and therapeutic methods in hospitals and outpatient clinics, and the
recommendations for the methadone maintenance programme.
The support is not only provided for opiate addicts, but also for the abusers of
sedatives, hypnotics, stimulants, hallucinogens etc., whether they experiment
with or are addicted to them.
The recommendations also provide guidance concerning the abstinence
syndrome, application of medicaments, stabilisation of opiate addicts, outpatient
treatment, detoxification and a detailed description of the methadone
maintenance programme.

Methadone maintenance programme policies were confirmed at a consensus
Symposium on methadone maintenance with participants from the Ministry of
Health, the Ministry of Internal Affairs, the Ministry of Labour, Family and Social
Affairs and the Ministry of Justice in November 1994.

Nine regional Centres for Prevention and Treatment of Drug Addictions were
established according to Degree of Minister of Health in April 1995.




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Table 12.2.1. Trend of no. of patients and funds for treatment of drug addiction
              from Health Insurrance Company

                                            No. of patients in
                                                                   No. of all patients
Year            Funds (in SIT and EUR)   methadone maintenance
                                              programme
1995                   78.962.546                  530                  No data
                     (352.511 EUR)


1996                   98.000.000                  530                  No data
                     (437.599 EUR)


1997                  141.243.949                  762                   1.414
                     (639.553 EUR)


1998                  173.566.015                  926                   2.599
                     (774.848 EUR)


1999                  206.054.000                 1.097                  2.342
                     (919.884 EUR)


2000                   214.877.000                 1.348                  2.540
                      (958.692 EUR              (1.11.2000)          (do 1.11.2000)
                     and 40.000.000
                     (178.571 EUR)
2001                   287.747.000                 1.347                 2.264
                    (1.284.585 EUR)             (31.3.2001)           (31.3.2001)
                      in 30.000.000
                     (933.929 EUR)

Source: Ministry of Health



At the end of the year 2001 there were fourteen Centres for the Prevention and
Treatment of Drug Addiction and three outpatient departments in Slovenia.


►Developments in inpatient treatment over the 1990s and 2000

Center for Treatment of Drug Addicts at the Clinical Department for Mental
Health at the Psychiatric Clinic Ljubljana was opened in January 1995.




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Table 12.2.2. Number of patients in the Centre for Treatment of Drug Addicts
              at Psychiatric Clinic Ljubljana - hospital unit

Year                           Women                  Men                      All
1995                                28                  52                     80
1996                                21                  56                     77
1997                                29                  54                     83
1998                                25                  68                     93
1999                                33                  68                 101
2000                                38                  71                 109
2001                                35                  79                 114
Total                              209                 448                 657

Source: Centre for Treatment of Drug Addicts at Psychiatric Clinic Ljubljana



Some of the specialist outpatient clinics for drug dependence treatment were
not operating very well. The need has arisen to establish a more efficient
network of drug prevention and rehabilitation centres in Slovenia which will
provide treatment, will be computer-linked and financially supported by the
Health Insurance Institute of Slovenia.

The expansion of the programme of the Centre for Treatment of Drug Addicts
with a specialist outpatient activity, treatment of youth, prolonged treatment and
rehabilitation as well as treatment of critical conditions occurring with drug
users, is of national importance and, in accordance with the national
programme, is a part of the obligatory health insurance scheme (Health Care
and Health Insurance Act, Official Gazette 9/92).

The contents of the programme of the Centre for Treatment of Drug Addicts has
been confirmed by the following conclusions:
 Conclusion of the RS Government Committee for the Implementation of the
   National Programme of Drug Abuse Prevention
 Conclusion of the State Collegiate Body for Psychiatry
 Conclusion of the Health Council

Premises for the expansion of the activity shall be assured in the building of the
former Military Hospital in Ljubljana, and these premises were, in accordance
with the government decision, allocated already in 1992.

In the Centre for Treatment of Drug Addicts the following activities will be
organised: a specialist outpatient activity, detoxification, prolonged treatment
and rehabilitation as well as treatment of crisis intervention occurring with drug
users.




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Establishment of the Centre for Treatment of Drug Addicts presents the
supplementation of the existing network of eleven Centres for Prevention and
Treatment of Drug Addictions in the Republic of Slovenia. The Centre will be
completed until summer 2002.


►Developments in low-threshold and outreach services over the 1990s
and 2000

In 1991 the group of different health and social professionals, drug users and
volunteers founded Stigma Association - the NGO for help, self-help,
information and advice on drugs and AIDS. The idea of harm reduction
approach in drug field in Slovenia was first developed and practised in Stigma
and after that advocated around the state. It was also used in the frame of drug
policy issues about pragmatically approaches in connection with more human
drug policy.
The first movement (it began after the first methadone substitution program at
the Psychiatric Hospital Vojnik in the city of Celje) was prohibited for several
months in 1989, when non-formal previous Stigma‟s members played the
crucial role in methadone treatment advocacy. It was the first time that the drug
users have made a public stand and engage themselves in a civil action. The
work on this topic went on in 1992 when Stigma managed to assemble a
number of professionals and drug users around issues of methadone, needle-
exchange, counselling about safer drug use, safer sex behaviour, self-help and
human rights of the drug users.

In 1995 the Republic of Slovenia was included in the project of WHO for
establish of outreach programmes, performing by the Ministry of Health.

In 2000 Stigma has merged with Aids Foundation Robert and remains the
project for harm reduction in the frame of new organisation.

The first service established – in low-threshold frame – was Stigma Association
in 1991. We start with programme in January 1992. Project contained needle
exchange service, help-line related to drugs & Aids, advocacy for methadone
maintenance treatment, ethnographic research related to drug use. Basic part
of the mentioned project was located only in Ljubljana, some other activities,
like »backing up« needle exchange supported by Stigma (user for users on
voluntary basis), was taking place in some other areas, mostly in city of Maribor.




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Table 12.2.3. Statistic from needle exchange

             Number of                 Number of                         Female        Male
                visits                   visitors                        visitors   visitors
1992            1.612     1992                446         1992           19,80%     80,20%
1993              2.044   1993                    418     1993           24,10%     75,90%
1994              1.310   1994                    306     1994           24,10%     75,90%
1995               940    1995                    225     1995           24,40%     75,60%
1996              1.799   1996                    368     1996           25,40%     74,60%
1997              1.324   1997                    297     1997           26,60%     73,40%
1998              3.823   1998                    630     1998           21,00%     79,00%
1999              3.868   1999                    740     1999           16,20%     83,80%
2000              7.892   2000                    963     2000           21,70%     78,30%
2001              7.718   2001                   1.131    2001           19,40%     80,60%


Source: Dare Kocmur, Stigma



Table 12.2.4. Statistic of issued and returned

                                 Issued                    Returned      Portion of returned

1992                               9.235                         5.191              56,20%
1993                              12.924                         6.664              51,60%
1994                              10.598                         4.603              43,40%
1995                               9.673                         1.488              15,40%
1996                              19.468                         5.860              30,10%
1997                              11.510                         4.066              35,30%
1998                              39.041                      19.190                49,15%
1999                              59.196                      30.941                52,30%
2000                             135.143                      75.228                55,67%
2001                             144.693                      98.815                68,29%

Source: Dare Kocmur, Stigma

Aids Foundation Robert contains three main projects:
 Project Stigma – harm reduction programme (the biggest one)
 Project Aids – mainly to deal with HIV infected persons, publishing
 Project prisons – harm reduction and social care with prisoners




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127
                                                      The Republic of Slovenia – ANEX 1
                                                                         REFERENCES



ANEX 1

References

1. Bevc M, Stergar M. Bilten slovenske mreţe zdravih šol. Ljubljana: Inštitut za
   varovanje zdravja Republike Slovenije, 1997

2. Council of Europe, Pompidou Group . Multi-city Study of Drug Misuse (Strasbourg:
   Council of Europe, 1987.

3. Council of Europe. Report Information Systems and Applied Epidemiology of Drug
   Misuse Follow-up Seminar. (P- PG ( 94) 20. Strasbourg, 1994.

4. Čelan Lucu B, Blaţevič S, Omahen L. Program Alfa; In: Heroin Addiction in Europe.
   Ljubljana: The Coordination of Centres for Prevention and Treatment of Drug
   Addiction at the Ministry of Health, 1997: 23

5. Darovec J, Jovanović, Kobal M, Markočič L, Milčinski I, Novak V, Ţmuc Tomori M.
   Načela zdravljenja in drugih postopkov pri odvisnostih od drog. Zdrav Var 1991; 30:
   103-16

6. Dekleva B, Nolimal D. Paradigma zmanjševanja škode v Sloveniji. Mreţa drog
   1997; 2-4; 5-7

7. Flaker V et al. Project " Stigma": The interim report to WHO, 1992.

8. Flaker V, Grebenc V, Rode N, Belin J, Fojan D, Grošičar A, Feher I, Šantelj M,
   Kastelic A, Zupančič D, Merdanović Z. Podobe uţivanja heroina v Sloveniji z vidika
   zmanjševanja škode:preliminarno poročilo o raziskavi. Soc. delo, 1999; 38, 4-6:
   341-393.

9. Flaker, V. (1992), Normalna droga - Epilog k vojni proti drogi. Droge na tehtnici,
   Časopis za kritiko znanosti, let. 20, 146-7: 193-200.

10. Flaker, V. (1993), s sodelavci Droge in nasilje. (raziskovalno poročilo), Ljubljana:
    Mirovni inštitut, 137 str.

11. Flaker, V., (1999), z Grebenc, V., Rode, N., Belin, J., Fojan, D. Grošičar A., Feher,
    I., Šantelj, M., Kastelic, A., Zupančič, D., Merdanović, Z.. Podobe uţivanja heroina
    v Sloveniji z vidika zmanjševanja škode : preliminarno poročilo o raziskavi. Soc.
    delo, 38, 4-6: 341-393. An English version: Landscapes of Heroin Use in Slovenia:
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12. Hartnoll R. A multicity network as an epidemiological information system. In:
    Estievenart G ed. Policies and strategies to combat drugs in Europe. Florence:
    European Commission, 1994




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                                                     The Republic of Slovenia – ANEX 1
                                                                        REFERENCES


13. Hartnoll R. recent trends in drug consumption, policy and research 1994:
    syntheseis of national reports. Strasbourg: Council of Europe ( P-PG/Epid (95)18,
    1995.

14. Hartnoll RL. et al. A multi city study of drug misuse in Europe, United Nations
    Bulletin on Narcotics, 1989; 16 : 3-27.

15. Hren J. UNAIDS Best Practice Collection. Drug Abuse and HIV/AIDS: Lessons
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16. Kastelic A, Kostnapfel RT. Treatment of addicts of prohibited drugs in Slovenia.
    Euro-Methwork Newsletter, 1996; 8: 11- 14.

17. Kastelic A, Kostnapfel Rihtar T. Javna zdravstvena sluţba. Mreţa centrov za
    preprečevanje in zdravljenje odvisnosti od prepovedanih drog. Kako preprečujemo
    in zdravimo odvisnosti od prepovedanih drog v sistemu zdravstvenega varstva,
    Ljubljana; Ministrstvo za zdravstvo, 2000.

18. Kastelic A, Kostnapfel Rihtar T. Javna zdravstvena sluţba. Mreţa centrov za
    preprečevanje in zdravljenje odvisnosti od prepovedanih drog. Priloga revije Odsev
    1999, leto1/štev.1.

19. Kostnapfel Rihtar T, Kastelic A, Krek M. Zdravljenje odvisnih od nedovoljenih drog -
    Vzpostavitev mreţe centrov; Zdrav Var 1995; 34: 575-9

20. Kastelic A, Kostnapfel Rihtar T. Konferenca »Odvisnost v Evropi«; ISIS 1998; 7: 62-3

21. Kastelic A. Priporočila zdravnikom za zdravljenje odvosnih od ilegalnih drog -
    delovni osnutek. In: Posvetovanje o problematiki metadona. Gozd Martuljek:
    Ministrstvo za zdravstvo, 1995: 17-62

22. Kostnapfel Rihtar T, Kastelic A. Zakonodaja na področju drog; Med Razgl 1996; 35:
    Suppl 5: 39-41

23. Kastelic A, Kostnapfel Rihtar A. Doses. What do patients need and want?
    (Comparison study 1995-1997); In: Heroin Addiction in Europe. Ljubljana: The
    Coordination of Centres for Prevention and Treatment of Drug Addiction at the
    Ministry of Health, 1997: 64

24. Kastelic A, Kostnapfel Rihtar T. Findings from the methadone maintenance
    program in the Republic of Slovenia; In: Heroin Addiction in Europe. Ljubljana: The
    Coordination of Centres for Prevention and Treatment of Drug Addiction at the
    Ministry of Health, 1997: 72

25. Kostnapfel Rihtar T. Kakovost storitve vzdrţevalnega metadonskega programa;
    Zdrav Var 1997; 36: Suppl 1

26. Kastelic A, Kostnapfel Rihtar T. Kaj je dobro vedeti o metadonu. Ljubljana: Zbirka
    Droge med nami, 1999.




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                                                     The Republic of Slovenia – ANEX 1
                                                                        REFERENCES


27. Kastelic A. Priporočila zdravnikom za zdravljenje odvisnih od ilegalnih drog.
    Ministrstvo za zdravstvo, 1995; 17-62. v Kostnapfel Rihtar T. (Ur.) Zbornik
    Posvetovanje o problematiki metadona. Ljubljana; Ministrstvo za zdravsto, 1995.

28. Kastelic A, Kostnapfel Rihtar T, Petrič VK. Navodila za cepljenje i.v. uţivalcev
    drog proti hepatitisu B. Ministrstvo za zdravstvo 1997.

29. Kostnapfel Rihtar T, Kastelic A. Findings from the methadone maintenance
    program in the Republic of Slovenia. Heroin Addiction and Related Clinical
    Problems 1999; 1 (2):10-11.

30. Kostnapfel Rihtar T. Quality of services in the Methadone Maintenance Program,
    Master study, Zagreb, 2000.

31. Kastelic A, Kostnapfel Rihtar T. Integrating Methadone Treatment in the Slovenian
    Public Health System. Heroin Addiction and Related Clinical Problems 1999; 1 (1):
    35-41.

32. Kostnapfel Rihtar T, Kastelic A.; The quality of methadone maintenance service
    in the Republic of Slovenia; 8th international conference on the reduction o drug
    related harm; Book of Abstracts, Paris, 3-27 marec 1997.

33. Kostnapfel Rihtar T, Kastelic A. Findings from the methadone maintenance
    program in the Republic of Slovenia. Heroin Addiction in Europe, Ljubljana, 17. -
    20.9.1997 - Book of Abstract; 72.

34. Kostnapfel Rihtar T. Kakovost storitve vzrţevalnega metadonskega programa v
    letih 1995 in 1997. Odvisnosti, leto 2, supl., september 2001; 13-54.

35. Kastelic A, Kostnapfel Rihtar T. Slovenia- Network of Centres for the Prevention
    and Treatment od Drug Addiction. UNAIDS Best Practice Collection. Drug Abuse
    and HIV/AIDS: Lessons learned. Case Studies Booklet. Central and Eastern
    Europe and the Central Asian States. United Nations, New York, 2001.

36. Kastelic A, Kostnapfel Rihtar T. Mreţa centara za prevencijo i liječenje narkomana
    u Republici Sloveniji. The network of centres for the prevention and treatment of
    drug addiction in the Republic of Slovenia. MED ARH, Sarajevo, 2001; 55(3): 135-
    139

37. Kostnapfel Rihtar T. Dvogodišnje praćenje kvalitete metadonskog programa.
    Magistarski rad. Sveučilište u Zagrebu, Medicinski fakultet. Zagreb, 2000.

38. Kastelic A, Kostnapfel Rihtar T. Klubske droge. Ljubljana; Zbirka Droge med nami,
    2000.

39. Kastelic A, Kostnapfel Rihtar T. Predoziranje (Overdoziranje). Zloţenka. Odsev se
    sliši, 2000.

40. Kastelic A, Kostnapfel Rihtar T. O odvisnostih. V zborniku Ocenjevanje
    delazmoţnosti pri odvisnosti od alkohola in drog ter epilepsiji, Rogaška Slatina
    2000; 131-136.




                                          130
                                                      The Republic of Slovenia – ANEX 1
                                                                         REFERENCES


41. Kostnapfel Rihtar T. Najnovejše smernice v zdravljenju opioidne odvisnosti v
    Zdruţenih drţavah Amerike. Odvisnosti, leto1, štev.1-2, maj 2000; 70

42. Krek M, Krek-Misigoj J, Nolimal D. Difficulties with field research of the illicit drug
    use. In: Nolimal D, Belec M, eds. Anthology of the papers presented at the
    Information Systems and Applied Epidemiology of Drug Misuse Follow-up Seminar.
    Ljubljana- Piran: Institute of Public Health, 1995 : 60-64.

43. Krek M, Mišigoj Krek J, Maslo M, Orbanič V, Merljak I. Pogostost uţivanja nekaterih
    drog med mladimi. Zdrav Var 1994; 33/Suppl.1.: 289-31.

44. Krek M, Nolimal D. The change of life style of methadone maintenance patients
    (Slov.) In: Slovenian Medical Association. Lifestyle and health. Portoroţ, 1993: 105
    -112.

45. Krek M, Mišigoj Krek J. Prevention activities in school, family and community; In:
    Heroin Addiction in Europe. Ljubljana: The Coordination of Centres for Prevention
    and Treatment of Drug Addiction at the Ministry of Health, 1997: 36

46. Kriţnik I, Šoltes V. The treatment program for drug misusing inmates in Slovenian
    prisons; In: Heroin Addiction in Europe. Ljubljana: The Coordination of Centres for
    Prevention and Treatment of Drug Addiction at the Ministry of Health, 1997: 75

47. Leskovšek E, Šoltes V. IDU and HIV prevention in Slovenian prisons ; In: Heroin
    Addiction in Europe. Ljubljana: The Coordination of Centres for Prevention and
    Treatment of Drug Addiction at the Ministry of Health, 1997: 86

48. Maremmani I, Canoniero S, Pacini M, Lovrecic M, Tagliamonte A: An eight year
    naturalistic observational study of heroin-addicted, methadone maintained
    psychiatric patients. In press.

49. Maslo M, Krek M. Vzgoja mladostnika za zdravo ţivljenje v prostem času. Zdrav
    Var 1994; 33; Suppl. 1: 257-269

50. Maslo M, Ličen I. Poročilo o delu lokalne akcijske skupine za preprečevanje
    tvegane in škodljive rabe drog v občini Piran. Mreţa drog 1996; 1: 10-20.

51. Maslo M. Attitudes of Slovenian pupils towards educational programmes on drug
    abuse. The European Network of Health Promoting Schools. Network news 1997 -
    third edition:6-7.

52. Maslo M. Moč in meje zdravstvene vzgoje o drogah med slovenskimi osmošolci.
    Mreţa drog 1996; 1: 37-42.

53. Maslo M. Stališča slovenskih osmošolcev Zdravih šol in drugih šol do vzgoje in
    izobraţevanja o drogah: diplomsko delo. Univerza v Ljubljani, Pedagoška fakulteta,
    Visoka šola za zdravstvo, oddelek za zdravstveno vzgojo. Ljubljana 1995.

54. Maslo M. Vloga medicinske sestre - profesorja zdravstvene vzgoje pri oblikovanju
    stališč o drogah med slovenskimi osmošolci zdravih in drugih šol. Obzor Zdr N
    1996; 30: 97-108.




                                           131
                                                     The Republic of Slovenia – ANEX 1
                                                                        REFERENCES


55. Maslo M. Zgodovina lokalne akcijske skupine za preprečevanje tvegane in škodljive
    rabe drog v občini Piran. Mreţa drog 1996; 1: 3-10.

56. Nastran Ule, M. (1996), Vrednote. V Nastran Ule, M. (ur.) (1996), Mladina v
    devetdesetih: Analiza stanja v Sloveniji. Ljubljana: Znanstveno in publicistično
    središče.

57. "Navodila za obravnavo odvisnih v zaporih" - Guidelines for treatment of drug
    addicts in prisons - document of Ministry of Justice and Ministry of Health of the
    Republic of Slovenia, 2000.

58. Nolimal D, Globočnik M, Rebec A, Krek M, Flaker V. Descriptive Epidemiology of
    the group of street injection drug users in the regions of Koper and Ljubljana in the
    year 1991. Zdrav Var 1993; 32: 161-4.

59. Nolimal D, Onusic S. Overview of drug misuse in Slovenia: Epidemiology and
    research. Ljubljana: Institute of Public Health of Slovenia, 1993.

60. Nolimal D, Premik M. Some social- medical aspects of drug abuse. Zdrav Vestn
    1992; 61: 133-6.

61. Nolimal D, Rode N, Lahajnar I, Dekleva B. Extent of drug abuse among high school
    students in Ljubljana in 1992. Zrav Var 1995; 34: 567 -74.

62. Nolimal D. Descriptive Epidemiology of the group of street injection drug users in
    the regions of Koper and Ljubljana. Zdrav Var 1993; 32: 161 -165

63. Nolimal D. Development of epidemiological activity in the frame of national
    programme for prevention of harmful drug consumption consequences in R
    Slovenia. In: Institute of Public Health. 1. slovenski kongres preventivne medicine.
    Zdrav Var 1995 34: 233-7.

64. Nolimal D. Drug abuse : basic goals and strategies of drug abuse prevention
    ( Slov.). Zdrav Var 1991;30:193-195.

65. Nolimal D. Drug abuse prevention and public health. In: Institute of Pharmacology.
    Use and abuse of psychoactive drugs. Ljubljana, 1992: 119 - 158.

66. Nolimal D, Kostnapfel Rihtar T, Cvelbar R. 26th Meeting of Experts in Epidemiology
    in Drug Problems: Slovenian National Report. Strasbourg: Council of Europe, 16-17
    June, 1997

67. Nolimal D. Implementation of first treatment demand indicator related to drug use
    following the methodology of Pompidou Group. Zdrav Var 1994; 33 : 337 -43.

68. Nolimal D. Prevention of alcohol, tobacco and other drug abuse in Slovenia today.
    Zdrav Var 1991; 30: 287 -90.

69. Nolimal D. Public health and data collecting about injection drug consumers in
    Slovenia in 1993. Zdrav Var 1994; 33: 327 -9.

70. Nolimal D. Risky and harmful use of drugs in Slovenia( Slov.).In: Institute of
    Pharmacy. Dependence Decease. Ljubljana, 1993: 55 -76.



                                           132
                                                    The Republic of Slovenia – ANEX 1
                                                                       REFERENCES



71. Nolimal D. Self help and methadone in Slovenia. Euro-Methwork Newsletter, 1996;
    7: 15.

72. Nolimal D. The consumption of drugs and public health in Slovenia ( Slov.).In:
    Institute of Pharmacy. Dependence Desease. Ljubljana, 1993: 77 -91.

73. Nolimal D. The extent of alcohol, tobacco and other drug abuse in Slovenia (Slov.).
    Zdrav Vestn 1992 ; 61 127 -31.

74. Nolimal D. The extent of alcohol, tobacco and other drug abuse in Slovenia.
    Ljubljana: University of Ljubljana School of Medicine, 1992 : 1- 57.

75. Nolimal D. The extent of drug abuse in Slovenia (Slov). In: Kastelic A (ed.). Drug
    abuse, University psychiatric hospital, 1992 :26-32.

76. Nolimal D. The new socio-medical aspects of drug abuse (Slov.). In: Institute of
    pharmacology. Use and abuse of psychoactive drugs, Ljubljana 1992: 119 - 158.

77. O'Hare A, Hartnoll RL. Final Report of The Dublin/London Drug Research project,
    Pompidou Group ( P-PG/Epid (89) 11. Strasbourg: Council of Europe, 1989.

78. Oraţem A, Nolimal D. The use of benzodiazepins in Slovenia (Slov.) Zdrav Var
    1991;30:197-198.

79. Petrič V., Nolimal D. Osnovne informacijske zahteve na področju uporabe in
    problematike drog. Med Razgl 1996; 35: Suppl 5: 161-168.

80. Petrič V. Outreach activity in Slovenia; In: Heroin Addiction in Europe. Ljubljana:
    The Coordination of Centres for Prevention and Treatment of Drug Addiction at the
    Ministry of Health, 1997: 116.

81. Pompidou Group. Further development of the first treatment demand indicator. (P-
    PG/Epid (90) 11 ). Strasbourg, Council of Europe, 1990.

82. Pravilnik o načinu izvajanja nadzora nad delom centrov za preprečevanje in
    zdravljenje odvisnosti od prepovedanih drog (Ur.list RS št. 43/00)

83. Pravilnik o delu Koordinacije centrov za preprečevanje in zdravljenje odvisnosti od
    prepovedanih drog (Ur.list RS št. 43/00)

84. Pompidou Group. Multicity network on drug misuse trends. Guidelines for city
    reports and annual updates ( P-PG/Epid (92)10 ) Strasbourg: Council of Europe,
    1992.

85. Rink I, Cvetek R, Retar I. Wind in your hear - Sport against drugs; In: Heroin
    Addiction in Europe. Ljubljana: The Coordination of Centres for Prevention and
    Treatment of Drug Addiction at the Ministry of Health, 1997: 123.

86. Rener T. et al. Global Approach to drugs. Copernicus project. In press.




                                          133
                                                        The Republic of Slovenia – ANEX 1
                                                                           REFERENCES


87. Stergar E, Šalehar Stupica M, Mikuš Kos A et al. Obvladovanje stresa ali kako
    ukrotiti tigra in se pri tem celo zabavati. Ljubljana: Inštitut za varovanje zdravja
    Republike Slovenije, 1996

88. Verster A., Buning E. Metadonske smernice. Slovenska priredba: Kastelic A.,
    Kostnapfel Rihtar T., Hvala Cerkovnik M.. Ministrstvo za zdravje RS, 2001.

89. The law on production of and trade in narcotic drugs and psychotropic substances
    (Official gazzette RS 108/99, 44/00)

90. The law on prevention of drug consumption and treatment of drug addicts (Official
    Gazzette 98/99).

91. Zakon o zdravstveni dejavnosti (Ur.l. RS, št. 9/1992, 13/1993, 9/1996, 29/1998,
    77/1998, 6/1999, 56/1999, 99/2001)

92. Zakon o zdravstvenem varstvu in zdravstvenem zavarovanju
    (Ur.list RS št. 9/92)

93. Zakon o zdravilih (Ur. list 101/99)

94. Precursors for illicit drugs act (Official gazzette 22/00)

95. Zakon o varnosti cestnega prometa. Official Gazette of the Republic of Slovenia,
    1998; 30: 1972-2015.




                                             134
                                               The Republic of Slovenia – ANEX 1
                                                                  REFERENCES


96. Morland J. On the frequent detection of drugged driving in Norway.
   Proceedings of the 15 the ICADTS Conference, T2000, Stockholm, May 22-
   26, 2000, www.ICADTS2000.com.

97. Stefanič B, Zorec Karlovšek M. Naše izkušnje po 12 mesečni uporabi
   “Naročila za zdravniško preiskavo zaradi ugotavljanja stanja pod vplivom
   alkohola, mamil in psihoaktivnih zdravil. In: ed.Balaţic B.Spominski
   memorial akademika Milčinskega, December 2000, Zbornik referatov,
   Inštitut za sodno medicino, Ljubljana (v tisku).




                                      135
                                        The Republic of Slovenia – ANEX 2
                 DRUG MONITORING SYSTEMS AND SOURCE OF INFORMATION



ANEX 2

Drug Monitoring Systems and source of information


1.    Evolution

The development of drug information system has been one of the priorities in
Slovenia since 1993. Slovenia participated in several international projects
concerning information system and data collection and by this a framework of
activities at a national level was established. Through cooperation with
international organisations, Phare-DIS/European Union and Pompidou
Group/Council of Europe in particular, the basis for the drug information system
were established - the network of people and institutions and the technical
network for the collection of reliable and comparable drug related data. At the
seminaries and meetings which were held in Slovenia with the international
support in the last years the information needs and demands were clarified.

The Institute of Public Health of Slovenia (IPH) is, together with 9 regional
Public Health Institutes, the most important data gathering centre on drugs in
Slovenia. The IPH is collecting treatment demand data since 1991. This year
the data collection started in Ljubljana and Koper.

The epidemiology experts of IPH and its regional branches meet regularly to
impart data comparability at national level and to compare and interpret drug
use and misuse trends.
The Unit of Mental Health Protection has been responsible for coordination and
contact with international organisations until March 2001. This Unit was
responsible for national epidemiology and prevention initiatives in the areas of
alcohol, drugs, suicides and others. The responsibility for the Pompidou Group
treatment demand and multi-city project was also with this Unit. In addition to its
responsibility for the national drug monitoring it has also offered support to
initiatives at local, regional, national and international levels to help
implemented a new epidemiology and prevention knowledge and methods.

Later, the CPTDAs became the main source of health data concerning drug
use. With non-governmental treatment and harm reduction services they build a
network of institutions that gives the opportunity of data collection at national
level. The first treatment demand data collection was implemented in June
1996. The existence of Coordination of CPTDAs on national level proved to
facilitate the implementation of FTD data collection.

At the Phare Information System Local Training Seminar at Bled in September
1996 epidemiologists from Regional Public Health Institutes realised and
accepted that FTD data should be in the first place collected, analysed and



                                       136
                                         The Republic of Slovenia – ANEX 2
                  DRUG MONITORING SYSTEMS AND SOURCE OF INFORMATION


disseminated directly by the Institute of Public Health at national level.
Collection of other drug data such as school and general population survey data
should remain in the domain of Regional Public Health Institutes.

In the field of drug control, The Ministry of Interior is a source of information
on police arrests, quantities of illicit drugs seized, prices of illicit drugs and drug-
related deaths; some data are available only for Slovenia and not for Ljubljana.
Based on the data on drug-related offences provided by the police and customs
officials, the annual report on drug delinquency in Slovenia is drawn.

The Ministry of Justice is a source of information on drug misuses in prison
population.


2.     Legislation
According to Prevention of the Use of Illicit Drugs and Dealing with Consumers
of Illicit Drugs Act Monitoring the consumption of illicit drugs was defined in
Article 15:
“Monitoring the consumption of illicit drugs is carried out in the form of
collection, arrangement, processing and providing of information on illicit drugs,
consumers of illicit drugs and consequences of the use of illicit drugs for the
purpose of ensuring a national information network, the inter-departmentally
coordinated collection of data and exchange of information on the national and
international levels.

The activities specified in the preceding paragraph shall be carried out by the
competent ministries, public institutions and non-governmental organisations.
The method of monitoring in the working areas of individual ministries shall be
set out in more detail by the competent minister.

Monitoring the consumption of illicit drugs shall be carried out pursuant to the
provisions that govern collections of data in the area of health and in
accordance with the act that governs the protection of personal data.

For the implementation of the activities specified in the first paragraph of this
article, the ministry responsible for health shall organise an illicit drug
information unit.

The information unit referred to in the preceding paragraph shall include all
competent ministries, public institutions and non-governmental organisations,
along with the collections of data in the area of illicit drugs which they have
available.”




                                          137
                                         The Republic of Slovenia – ANEX 2
                  DRUG MONITORING SYSTEMS AND SOURCE OF INFORMATION


With the Health Minister Order (no. 5809-2/01, dated March 8, 2001)
Informational Unit for Drugs was formally established at the Institute of Public
Health of the Republic of Slovenia.

It is considered as a Focal Point and a central unit for drug data collection.


3.      Sources of information

3.1. Epidemiology

The most important sources for epidemiological drug data are:

   Institute of Public Health of the Republic of Slovenia with its nine
    Regional Institutes
Some data are routinely reported by means of health statistics: hospital
admissions, viral hepatitis B (but not data on drug related cases), AIDS, causes
of death and data on school survey.
Reporting system according to the first treatment demand indicator is not
completely established yet. Only data from CPTDAs are available.
.

 The Ministry of Health
Various data on CPTDAs and Centre for Treatment of Drug Addiction are
available at the ministry.

 The Ministry of Internal Affairs
Information on police arrests, quantities of illicit drugs seized, prices of illicit
drugs and drug related deaths could be drawn from the data.

    The Ministry of Justice - prison data

 The Ministry of Labour, Family and Social Affairs
Social care treatment data are available on drug users.

 Aids Foudation Robert and Stigma
Data on needle exchange and outreach are available.

 DrogArt - Slovenian Association for drug related harm reduction
Data on ATS and dance drugs.

 The Sound of Reflection Foundation
Data on Conferences, manuals, counselling services…




                                          138
                                       The Republic of Slovenia – ANEX 2
                DRUG MONITORING SYSTEMS AND SOURCE OF INFORMATION



3.2. Demand reduction

Information about demand reduction is primarily available at the Governmental
office for Drugs since the president was also DDRP coordinator.
The ministries possess information on DDR relevant to their sector.

At the regional level information on DDR can be found at the local action teams
and in regional Public Health Institutes.

In the town of Ljubljana relevant information is gathered at the Drug Prevention
Office.


3.3. Documentation centres

There is no separate drug documentation centre in Slovenia. The
documentation where most of the relevant drug information can be found is
INDOK Centre at the Institute of Public Health.
A lot of information and publications are available also at the Governmental
Office for Drugs, where the drug documentation centre is being established.

Slovenia is reporting to several international organisations on regular and
occasional basis. UNDCP questioners are completed, reports to international
organisations such as Phare and Pompidou Group are prepared. Police is
reporting to INTERPOL and EUROPOL. According to international cooperation
in specific projects reports are prepared.
There is no common report, covering all structures and activities, that could be
used as a national report.




                                      139
                                                  The Republic of Slovenia – ANEX 3
                                                         LIST OF ABBREVIATIONS



ANEX 3

List of Abbreviations

ATS        Amphetamine type stimulants
BKA        Federal Criminal Police Office of Germany (Bundeskriminalamt)
CPTDA      Centres for the Prevention and Treatment of Drug Addiction
CEECs      Convergence of the Central and Eastern European Countries
CEI        Central European Initiative
DDR        Drug Demand Reduction
DIS        Drug Information System
DTD        Drug treatment Demand
EMCDDA     European Monitoring centre for Drugs and Drug Addiction
ESPAD      European School Project on Alcohol and Drugs
EU         European Union
EUROPAD    European Opiate Addiction Treatment Association
FBI        Federal Biro of Investigations of United States of America
FP         Focal Point
FTD        First Treatment Demand
HPS        Health Promoting Schools
ICD        International Code of Diagnoses
IDU        Injecting Drug Users
ILEA       International Law Enforcement Training Academy (FBI)
ILO        International Labour Organisation
ISAM       International Society of Addiction Medicine
LAT        Local Action Team
MEPA       Middle European Police Academy
MMP        Methadone Maintenance Program
MSM        Man who had Sexual contact with Man
NGO        Non - governmental Organisation
PG         Pompidou Group
PHI        Public Health Institute of Slovenia
           European Information network on Drugs and Drug Addiction (Réseau Européen
REITOX      ,
           d Information sur les Drogues et les Toxicomanies)
SNHPS      The Slovene Network of Health Promoting Schools
Ur. list   National Gazette
UNDCP      United Nations International Drug Control Programme
WHO        The World Health Organisation




                                        140
                                                                      The Republic of Slovenia – ANEX 4
                                                                                       LIST OF TABLES



ANEX 4

List of Tables


Table 2.1.1.    The lifetime prevalence of drug use between partygoers in Slovenia ... 19
Table 2.2.1.    School survey data, Slovenia, 1999 ..................................................... 23
Table 2.2.2.    Number of prisoners with drug problems compared to a total prison
                population ............................................................................................ 25
Table 3.4.1.    The number of requests for toxicological analysis in cases of
                suspicion of drug impaired driving ........................................................ 36
Table 3.4.2.    Frequency at which drugs were encountered ....................................... 36
Table 4.2.1.    Number of Criminal offences and Misdemeanours ............................... 42
Table 4.2.2.    Number of Criminal offences and Misdemeanours from 1991 to 2001 . 42
Table 5.2.2.    Seizures of illicit drugs ......................................................................... 46
Table 9.2.1.    Issued and returned syringes ............................................................... 68
Table 9.3.1.    Number of patients In Centres for the Prevention and Treatment of
                Drug Addiction from April 1995 to March 2001 ..................................... 77
Table 9.3.2.    Number of patients in the Centre for Treatment of Drug Addicts at
                Psychiatric Clinic Ljubljana - hospital unit ............................................ 78
Table 9.3.3.    Number of patients in the Centre for Treatment of Drug Addicts at
                Psychiatric Clinic Ljubljana - outpatient unit.......................................... 78
Table 9.3.4.    Number of Prisoners dependent on Drugs for Individual Years in
                relations to the Total Number of Prisoners ........................................... 92
Table 9.3.5.    Number of Prisoners infected with the Hepatitis Virus .......................... 92
Table 9.3.6.    Number of Prisoners tested and Number testing positive to AIDS ........ 93
Table 9.6.1.    Mean values with standard deviations or percentages ......................... 97
Table 9.6.2.    Mean values with standard deviations or percentages ......................... 98
Table 10.3.     Risk associated with the sharing of the equipment: factors, rates,
                points of risk and risk reduction .......................................................... 106
Table 11.2.1.   Injecting risk behaviour among IDU clients demanding treatment
                for the first time in the network of Centres for Prevention and
                Treatment of Illicit Drug Users ............................................................ 116
Table 11.2.2.   Sexual behaviour among IDU using clients demanding treatment
                for the first time in the network of Centres for Prevention and
                Treatment of Illicit Drug Users ............................................................ 118
Table 12.2.1.   Trend of no. of patients and funds for treatment of drug addiction
                from Health Insurrance Company....................................................... 123
Table 12.2.2.   Number of patients in the Centre for Treatment of Drug Addicts at
                Psychiatric Clinic Ljubljana - hospital unit ........................................... 124
Table 12.2.3.   Statistic from needle exchange .......................................................... 126
Table 12.2.4.   Statistic of issued and returned .......................................................... 126




                                                       141
                                                                     The Republic of Slovenia – ANEX 5
                                                                                     LIST OF FIGURES



ANEX 5

List of Figures


Figure 2.2.2. Key Slovenian results, compared to European average, 1999 ............. 24
Figure 3.1.1. Drug treatment demand, Slovenia, 2000 (N=946) ................................ 29
Figure 3.2.2. Mortality rate per 100.000 population by age groups and gender
               (Slovenia 1985 -2000) .......................................................................... 31
Figure 3.2.3. Mortality rate due to drug use population for population
               aged 15 to 49 by gender (1985 -2000) ................................................. 31
Figure 3.2.4. Mortality rate due to drug use by birth cohort (1985 -1999) .................. 32
Figure 4.2.1. Number of Criminal offences and Misdemeanours ............................... 43
Figure 5.2.1. Numbers of seizures of heroin ............................................................. 44
Figure 5.2.2. Numbers of seizures of ecstasy and cannabis unit ............................... 45
Figure 5.2.3. Numbers of seizures of cannabis ......................................................... 45
Figure 9.1.1. The activities of SNHPS by content in the s. y. 2000/01 (all schools) ... 59
Figure 9.3.1. Number of patients in Centres for the Prevention and
               Treatment of Drug Addiction from April 1995 to March 2001 ............... 77
Figure 9.3.2. The possibilities of participating in psychosocial treatment ................... 82
Figure 9.3.3. Testing of urine on drugs...................................................................... 83
Figure 9.3.4. Selling methadone ............................................................................... 84
Figure 9.3.5. Usefulness of methadone maintenance programme ............................ 85
Figure 9.3.6. Expectations of clients from the methadone maintanence program...... 87
Figure 10.2.1. Types of methadone treatment programmes ...................................... 101
Figure 10.2.2. Gender of clients who participated in the methadone maintenance
               programme, 1995, 1997 and 2000 ..................................................... 102
Figure 10.2.3. Average age....................................................................................... 102
Figure 10.2.4. Level of education .............................................................................. 103
Figure 10.2.5. Employment ....................................................................................... 103
Figure 10.2.6. Testing on HCV.................................................................................. 104
Figure 10.2.7. Vaccination against hepatitis B........................................................... 104




                                                        142
                                                   The Republic of Slovenia – ANEX 6
                                                            LIST OF INSTITUTIONS



ANEX 6

List of Institutions

AIDS Fondacija Robert                                 Wolfova ulica 8
                                                      1000 Ljubljana
AMOS – Akademsko katoliško zdruţenje                  Koroška cesta 1
                                                      2000 Maribor
AN-AN Ţiga in Cuderman d.n.o.                         Celovška cesta 79
                                                      1000 Ljubljana
ARS VITAE PTUJ                                        Trstenjakova ulica 5a
                                                      2250 Ptuj
B & Z d.o.o. (inţeniring za izobraţevanje,            Grablovičeva ulica 1
svetovanje in raziskave
                                                      1000 Ljubljana
Center za socialno delo Ilirska Bistrica              Levstikova ulica 3
                                                      6250 Ilirska Bistrica
Center za socialno delo Izola                         Pittonijeva ulica 2
                                                      6310 Izola
Center za socialno delo Kamnik                        Ljubljanska cesta 1
                                                      1240 Kamnik
Center za socialno delo Kranj                         Slovenski trg 1
                                                      4000 Kranj
Center za socialno delo Ljubljana Beţigrad            Podmilščakova ulica 20
                                                      1000 Ljubljana
Center za socialno delo Ljubljana                     Alternative – Prizadevanja,
Moste – Polje                                         povezana s teţavami zaradi
                                                      uporabe drog
                                                      Kersnikova ulica 4
                                                      1000 Ljubljana
Center za socialno delo Ljubljana Moste – Polje       Svetovalnica Fuţine – projekt
                                                      Korak
                                                      Preglov trg 15
                                                      1000 Ljubljana
Center za socialno delo Ljubljana Vič – Rudnik        Trţaška cesta 2
                                                      1000 Ljubljana
Center za socialno delo Logatec                       Trţaška cesta 13
                                                      1370 Logatec
Center za socialno delo Murska Sobota                 Slovenska ulica 44
                                                      9000 Murska Sobota
Center za socialno delo Piran                         Ţupančičeva ulica 24
                                                      6330 Piran
Center za socialno delo Seţana                        Kosovelova ulica 4b
                                                      6210 Seţana




                                             143
                                                  The Republic of Slovenia – ANEX 6
                                                           LIST OF INSTITUTIONS


Center za socialno delo Šmarje pri Jelšah            Celjska cesta 12
                                                     3240 Šmarje pri Jelšah
Center za socialno delo Tolmin                       Cankarjeva ulica 6
                                                     5220 Tolmin
Center za socialno delo Trţič                        Predilniška cesta 16
                                                     4290 Trţič
Društvo anonimnih alkoholikov (skupnost AA)          Podmilščakova ulica 14
                                                     1000 Ljubljana
Društvo "Projekt Človek"                             Malenškova ulica 11
                                                     1000 Ljubljana
Društvo Smisel ţivljenja Postojna                    Trţaška cesta 36
                                                     7000 Postojna
Društvo staršev za pomoč mladini                     Ulica Savinjske čete 4
                                                     3310 Ţalec
Društvo za pomoč in samopomoč na                     Roţnodolska ulica 34
področju zasvojenosti "Zdrava pot" Maribor
                                                     2000 Maribor
Društvo za pomoč mladim "Korak naprej"               Zdravstvena postaja Beltinci
                                                     Cvetno naselje 1
                                                     9231 Beltinci
Društvo za pomoč odvisnikom in njihovim              Ulica 1. maja 1
druţinam "PO MOČ" Seţana
                                                     6210 Seţana
Društvo za preventivno delo                          Trţaška cesta 2
                                                     1000 Ljubljana
Društvo za rehabilitacijo in preventivo Krma         Cesta maršala Tita 65
                                                     4270 Jesenice
Društvo za razvoj in izvajanje povezovanja na        Meškova ulica 2
prijaznejši osnovi Zarja
                                                     2380 Slovenj Gradec
Febris d.o.o.                                        Ambulanta za preprečevanje in
                                                     zdravljenje odvisnih od
                                                     prepovedanih drog
                                                     Kolodvorska cesta 24
                                                     6257 Pivka
Freeart d.n.o. (Techno duhec)                        Slovenska cesta 29
                                                     1234 Mengeš
Fundacija "Z glavo na zabavo"                        Koseška cesta 8
                                                     1117 Ljubljana
Gimnazija Piran                                      Spodbujanje socialnega učenja
                                                     Bolniška ulica 11
                                                     6330 Piran
Inštitut za sodno medicino Medicinske fakultete      Korytkova ulica 2/III
Univerze v Ljubljani
                                                     1000 Ljubljana
Inštitut za varovanje zdravja RS                     Trubarjeva cesta 2
                                                     1000 Ljubljana




                                            144
                                                  The Republic of Slovenia – ANEX 6
                                                           LIST OF INSTITUTIONS



Izobraţevalno društvo za pomoč odvisnikom "Šterna"   Ţupančičeva ulica 6
                                                     6000 Koper
Jona – Društvo mladih kristjanov                     Skupnost Canacolo
                                                     Trg sv. Mavra 4
                                                     6310 Izola
Karitas Portoroţ                                     Cvetna pot 4
                                                     6320 Portoroţ
Mestna občina Ljubljana, Urad za                     Resljeva ulica 18
preprečevanje zasvojenosti
                                                     1000 Ljubljana
Mestna občina Velenje                                Medobčinska lokalna akcijska
                                                     skupina (LAS) za preprečevanje
                                                     zasvojenosti z drogami v
                                                     Mestni občini Velenje, občini
                                                     Šoštanj in občini Šmartno ob Paki
                                                     Titov trg 1
                                                     3320 Velenje
Mladinski center dravinjske doline (MCDD)            Celjska cesta 16
                                                     3210 Slovenske Konjice
Mladinsko informativno svetovalno središče           Kunaverjeva ulica 2
Slovenije – MISSS
                                                     1000 Ljubljana
Občina Jesenice                                      Lokalna akcijska skupina (LAS)
                                                     Ulica maršala Tita 78
                                                     4270 Jesenice
Občina Kočevje                                       Lokalna akcijska skupina (LAS)
                                                     Ljubljanska cesta 26
                                                     1330 Kočevje
Občina Kranjska Gora                                 Lokalna akcijska skupina (LAS)
                                                     Kolodvorska ulica 1a
                                                     4280 Kranjska Gora
Občina Rogaška Slatina                               Mladinske delavnice
                                                     Izletniška 2
                                                     3250 Rogaška Slatina
Občina Slovenske Konjice                             Lokalna akcijska skupina (LAS)
                                                     Stari trg 29
                                                     3210 Slovenske Konjice
Osnovna šola Lucija                                  Uspešnost v šoli in razvoj pozitivne
                                                     samopodobe in Srečanja s starši
                                                     Fazan 1
                                                     6320 Portoroţ
Osnovna šola Sečovlje                                Svetloba, zdravje, mladost
                                                     Sečovlje 78
                                                     6333 Sečovlje




                                            145
                                                     The Republic of Slovenia – ANEX 6
                                                              LIST OF INSTITUTIONS



"Ptica" – Društvo za mlade Zasavje                      Novi dom 4
                                                        1430 Hrastnik
Preobrazba - zasebna psihiatrična ordinacija            Zasavska cesta 42
                                                        1231 Ljubljana-Črnuče
Psihiatrična klinika Ljubljana                          Center za zdravljenje odvisnih od
                                                        prepovedanih drog
Klinični oddelek za mentalno zdravje                    Zaloška cesta 29
                                                        1000 Ljubljana
Psihiatrična klinika Ljubljana                          Enota za zdravljenje odvisnih od
                                                        alkohola
Klinični oddelek za mentalno zdravje                    Poljanski nasip 58
                                                        1000 Ljubljana
Sana Vita Zavod Ljubljana                               Masarykova cesta 23
                                                        1000 Ljubljana
Svetovalni center za otroke, mladostnike in starše      Gotska ulica 18
                                                        1000 Ljubljana
Svit – Društvo za pomoč odvisnikom in                   Ţupančičeva ulica 6
njihovim druţinam
                                                        6000 Koper
Športna unija Slovenije                                 Veter v laseh, s športom proti drogi
                                                        Tabor 14
                                                        1000 Ljubljana
Timotej – Ptuj, Društvo za izboljšanje                  Aškerčeva ulica 4
kvalitete ţivljenja
                                                        2250 Ptuj
"Up" – Društvo za pomoč zasvojencem in                  Miklošičeva cesta 16
njihovim svojcem Slovenije
                                                        1000 Ljubljana
Ustanova "Odsev se sliši"                               Svetovalnica
                                                        Gornji trg 24
                                                        1000 Ljubljana
Konoplja.org (www.konoplja.org)                         Mariborska ulica 2
                                                        3000 Celje
Zavod Janeza Smrekarja, OE Skala                        Skala – mladinska ulična vzgoja
                                                        Rakovniška ulica 6
                                                        1000 Ljubljana
Zavod Pelikan – karitas                                 Litijska cesta 24
                                                        1000 Ljubljana
Zavod Vir – Preprečevanje odvisnosti in                 Gregorčičeva ulica 6
rehabilitacija uporabnikov drog
                                                        3000 Celje
Zavod za zdravstveno varstvo Celje                      Ipavčeva ulica 18
                                                        3000 Celje
Zavod za zdravstveno varstvo Kranj                      Gosposvetska ulica 12
                                                        4000 Kranj
Zavod za zdravstveno varstvo Ljubljana                  Zaloška cesta 29
                                                        1000 Ljubljana




                                          146
                                                  The Republic of Slovenia – ANEX 6
                                                           LIST OF INSTITUTIONS


Zavod za zdravstveno varstvo Maribor                 Center za preprečevanje
                                                     odvisnosti
                                                     Ljubljanska ulica 4
                                                     2000 Maribor
Zavod za zdravstveno varstvo Murska Sobota           Ulica arhitekta Novaka 2b
                                                     9000 Murska Sobota
Zavod za zdravstveno varstvo Nova Gorica             Kostanjeviška cesta 16 a
                                                     5000 Nova Gorica
Zavod za zdravstveno varstvo Ravne na Koroškem       Ob Suhi 11 a
                                                     2390 Ravne na Koroškem
Zdravstveni dom Breţice                              Center za preprečevanje in
                                                     zdravljenje odvisnosti od
                                                     prepovedanih drog
                                                     Černelčeva cesta 8
                                                     8250 Breţice
Zdravstveni dom Celje                                Center za preprečevanje in
                                                     zdravljenje odvisnosti od
                                                     prepovedanih drog
                                                     Gledališka ulica 4
                                                     3000 Celje
Zdravstveni dom dr. Adolfa Drolca Maribor            Center za preprečevanje in
                                                     zdravljenje odvisnosti od
                                                     prepovedanih drog
                                                     Ulica talcev 9
                                                     2000 Maribor
Zdravstveni dom Ilirska Bistrica                     Ambulanta za preprečevanje in
                                                     zdravljenje odvisnosti od
                                                     prepovedanih drog
                                                     Gregorčičeva cesta 8
                                                     6250 Ilirska Bistrica
Zdravstveni dom Jesenice                             Ambulanta za preprečevanje in
                                                     zdravljenje odvisnosti od
                                                     prepovedanih drog
                                                     Cesta maršala Tita 65
                                                     4270 Jesenice
Zdravstveni dom Jesenice                             Mentalno higienski dispanzer
                                                     Cesta maršala Tita 78
                                                     4270 Jesenice
Zdravstveni dom Koper                                Center za preprečevanje in
                                                     zdravljenje odvisnosti od
                                                     prepovedanih drog
                                                     Santorijeva 9
                                                     6000 Koper
Zdravstveni dom Kranj                                Center za preprečevanje in
                                                     zdravljenje odvisnosti od
                                                     prepovedanih drog
                                                     Gosposvetska ulica 9
                                                     4000 Kranj




                                            147
                                              The Republic of Slovenia – ANEX 6
                                                       LIST OF INSTITUTIONS



Zdravstveni dom Ljubljana, OZV enota Center      Center za preprečevanje in
                                                 zdravljenje odvisnosti od
                                                 prepovedanih drog
                                                 Metelkova ulica 9
                                                 1000 Ljubljana
Zdravstveni dom Logatec                          Center za preprečevanje in
                                                 zdravljenje odvisnosti od
                                                 prepovedanih drog
                                                 Notranjska ulica 2
                                                 1370 Logatec
Zdravstveni dom Murska Sobota                    Center za preprečevanje in
                                                 zdravljenje odvisnosti od
                                                 prepovedanih drog
                                                 Grajska ulica 24
                                                 9000 Murska Sobota
Zdravstveni dom Nova Gorica                      Center za preprečevanje in
                                                 zdravljenje odvisnosti od
                                                 prepovedanih drog
                                                 Rejčeva ulica 4
                                                 5000 Nova Gorica
Zdravstveni dom Novo mesto                       Center za preprečevanje in
                                                 zdravljenje odvisnosti od
                                                 prepovedanih drog
                                                 Kandijska cesta 4
                                                 8000 Novo mesto
Zdravstveni dom Piran – Lucija                   Center za preprečevanje in
                                                 zdravljenje odvisnosti od
                                                 prepovedanih drog
                                                 Cankarjevo nabreţje 9a
                                                 6330 Piran
Zdravstveni dom Seţana                           Center za preprečevanje in
                                                 zdravljenje odvisnosti od
                                                 prepovedanih drog
                                                 Partizanska cesta 24
                                                 6210 Seţana
Zdravstveni dom Trbovlje                         Center za preprečevanje in
                                                 zdravljenje odvisnosti od
                                                 prepovedanih drog
                                                 Rudarska cest 12
                                                 1420 Trbovlje
Zdravstveni dom Trţič                            Ambulanta za preprečevanje in
                                                 zdravljenje odvisnosti od
                                                 prepovedanih drog
                                                 Blejska cesta 10
                                                 4290 Trţič
Zdravstveni dom Velenje                          Center za preprečevanje in
                                                 zdravljenje odvisnosti od
                                                 prepovedanih drog
                                                 Vodnikova cesta 1
                                                 3320 Velenje




                                        148
                                                   The Republic of Slovenia – ANEX 6
                                                            LIST OF INSTITUTIONS



Zdruţenje DrogArt                                     Kolodvorska ulica 20
                                                      1000 Ljubljana
Zveza društev na področju drog                        Sketova ulica 5
                                                      1000 Ljubljana
Zveza društev prijateljev mladine Jesenice            Pod gozdom 2
                                                      4270 Jesenice

Source: Governmental Office for Drugs




                                             149
                                    The Republic of Slovenia – ANEX 7
                           STANDARDISED EPIDEMIOLOGICAL TABLES



ANEX 7

Standardised Epidemiological Tables




                             150

								
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